Department of Administrative Services

Nurse Advocate (35 Hour) (5901HC)

$35.69-$48.32 Hourly / $2,498.01-$3,382.46 BiWeekly /
$65,198.06-$88,282.21 Yearly


PURPOSE OF JOB CLASS (NATURE OF WORK)

In the Office of the Health Care Advocate, this class is accountable for independently performing a full range of duties by providing consultation and advocacy to consumers regarding health plan coverage and/or health care services.

SUPERVISION RECEIVED

Works under the general supervision of a Nurse Consultant or an employee of a higher grade.

SUPERVISION EXERCISED

May lead lower level employees as assigned.

EXAMPLES OF DUTIES

Serves as a resource to consumers, family members, health care providers, attorneys, government agencies and other interested parties on health care plan coverage and services; interprets health care plan coverage and provides guidance on an individual’s right to services; analyzes complaints for possible violation of state statutes, regulations and guidelines; conducts interviews and researches and gathers data to support insurance coverage and payment; investigates consumer complaints against insurance companies; reviews medical records and consults with treating physician and other medical experts to build cases for "medical necessity" under Connecticut law; assists consumers with the filing of complaints and appeals; advises consumers and providers on testimony and attends appeal hearings; ensures that appeal is properly documented and witnesses are prepared for appeal hearings; refers cases to other state agencies in consultation with supervisor; participates in health fairs and other forums; participates in internal case review meetings; may conduct outreach; performs related duties as required.

KNOWLEDGE, SKILL AND ABILITY

Considerable knowledge of medical terminology and procedures; knowledge of relevant State and Federal laws, statutes and regulations; knowledge of principles and practices of nursing care administration for a variety of specialties with varied settings; knowledge of health insurance and managed care practices; knowledge of state insurance law; some knowledge of the impact of the federal Employee Retirement Income Security Act (ERISA) on state regulation of insurance; considerable interpersonal skills; oral and written communication skills; considerable ability to problem solve; ability to understand and communicate health programs and insurance plans; ability to understand external insurance appeal processes; ability to prepare cases for presentations to insurance providers; ability to utilize computer software.

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

Three (3) years of experience as a professional nurse in a position involving medical/surgical or mental health practices.

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

Two (2) years of the General Experience must have been as a utilization review nurse or as a nurse in the health insurance or healthcare industry on insurance coverage activities.

MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED

1. A Master's degree in nursing may be substituted for the General and Special Experience.
2. A Master's degree in health services administration or public health may be substituted for one (1) additional year of the General Experience.
3. A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.

SPECIAL REQUIREMENTS

1. Incumbents in this class must possess and maintain a current license as a registered professional nurse in Connecticut.
2. Incumbents in this class may be required to travel.
3. Incumbents in this class may be required to possess and maintain a valid motor vehicle Operator's license.

JOB CLASS DESIGNATION

Classified/Non-Examined

OCCUPATIONAL GROUP

(22)-Nursing

BARGAINING UNIT

(11)-HEALTH PROF (P-1)

EEO

(2)-Professional

SALARY INFORMATION

HC 24

CANCELLATION CLAUSE

This replaces the existing specification for the class of Nurse Advocate in Salary Group HC 24 approved effective February 20, 2015. (Revised to change Pay Plan and modify Substitutions Allowed)

EFFECTIVE DATE

3/17/2017

CLASS: 5901HC; EST: 2/20/2015; REV: 3/17/2017;