PURPOSE OF JOB CLASS (NATURE OF WORK)
In the Departments of Public Health, Children and Families, Correction, Developmental Services, Mental Health and Addiction Services, Social Services and the Office of Early Childhood, this class is accountable for applying professional nursing knowledge in the enforcement, inspection, licensure, consultation and implementation or assessment of the nursing service component of health care programs and facilities.
In the Office of the Healthcare Advocate, Consumer Affairs area, this class is accountable for acting as a supervisor and responsible for independently performing a full range of duties related to health insurance consumer education, case management and advocacy and assessing compliance of health insurance companies with various state statutes, regulations and guidelines.
In the Office of the State Treasurer, Second Injury and Assurance Fund, this class is responsible for managing, directing, implementing and monitoring programs involving medical cost containment and disability management relating to occupational injuries and loss control matters.
Works under the general supervision of a Supervising Nurse Consultant or other employee of higher grade.
May supervise/lead professional and clerical staff as assigned.
EXAMPLES OF DUTIES
ALL PARENTHETICALS: Implements, coordinates, and evaluates activities of assigned programs or health care services; maintains active liaison with and serves as nursing consultant to other sections, divisions, health care providers and public; may inspect and evaluate health care and psychiatric facilities for compliance with state and federal regulations including licensure and certification laws; assesses safety and quality of client care provided; assesses compliance of health insurance companies with various state statutes, regulations and guidelines; performs related duties as required.
PUBLIC HEALTH: Provides consultation to state licensed health care facilities and institutions and to unlicensed facilities to bring them into compliance with statutes, community institutions and individuals regarding planning, implementation and evaluation of nursing services, home health services and specialized problems in public health; performs on-site inspection surveys of health care or psychiatric facilities and provides consultation regarding licensure and certification laws, regulations and policies; evaluates quality of services rendered by facility; monitors facilities during strikes; prepares relevant federal and state forms and reports; may testify in court relative to findings of inspections and/or investigations; performs related duties as required.
GENERAL: Provides consultation and reviews, evaluates and authorizes requests for medical placement services or equipment for clients covered under medical assistance programs; evaluates requests from health care providers asking to be included in medical assistance programs and offers consultation regarding interpretation of programs, policies and regulations; performs related duties as required.
CHILDREN AND FAMILIES: In a central office assignment or region-wide basis, plans, reviews, and evaluates the coordination, assessment and monitoring of health services to DCF children; assists in the development of policies and procedures related to health and wellness/nursing standards of practice; provides consultation to community hospitals, medical facilities, community providers, schools, foster parents, other state agencies and the court system regarding the health needs of DCF children; provides consultation to Careline Special Investigations Unit on medical investigations of abuse and neglect; develops nursing and individual professional development/trainings; may review all multidisciplinary evaluations, including the child's medical, dental, developmental, behavioral health and trauma needs, including consents for surgeries/medical procedures and/or medically complex cases; may have oversight and coordination of children's health plans; may have oversight of state-wide health trainings, health programs, contracts and health initiatives; may develop, provide and monitor health trainings to DCF caregivers, staff, community providers and youth; performs related duties as required.
EARLY CHILDHOOD: Monitors the enforcement of child day care programs and youth camps licensure; provides consultation regarding licensure and certification laws, regulations and policies; evaluates quality of services rendered by facility; monitors all medication administration by unlicensed personnel in these programs; provides technical assistance to programs requiring childhood immunization and presenting medical conditions; acts as a resource to programs regarding infectious diseases, bioterrorism, and emergency preparedness and other child health issues; performs on-site inspections of complaints concerning the administration of medications, diseases outbreaks, child abuse and neglect and child deaths and serious injuries in child day care programs and youth camps; prepares relevant state forms and reports; testifies at formal hearings and court proceedings; performs related duties as required.
DEVELOPMENTAL SERVICES: On a region-wide basis, plans, reviews and evaluates the coordination, assessment and monitoring of health services; provides consultation to community health care providers, private residential and day program providers and families; recommends standards of care for State and private facilities; performs related duties as required.
HEALTH CARE ADVOCATE: Within a unit, coordinates work flow and determines priorities to assure highest quality of consumer service; schedules, assigns, oversees and reviews work; establishes and maintains program protocols and procedures; provides staff training and assistance; conducts or assists in conducting performance evaluations; investigates consumer complaints against insurance companies; analyzes complaints for possible violation of state statutes, regulations and guidelines; leads internal case review; reviews medical records and consults with treating physician and other medical experts to build cases for "medical necessity" under Connecticut law; coordinates internal and external consumer appeals; liaison with health plan providers, consumers, families, government agencies; interviews consumers, families and providers to collect facts related to an appeal; drafts testimony for consumer and providers for appeal hearings; leads consumer presentation at appeal hearings; refers cases to other state agencies in consultation with Program Manager; assists in the design of and participates in agency quality improvement activities; develops and conducts outreach, presentations and front-line consumer education through the toll-free line or participates in health fairs; performs related duties as required.
MENTAL HEALTH AND ADDICTION SERVICES: Coordinates and supervises a program of clinical data collection as it relates to specific state and federal legislation; develops, implements and evaluates instruments used in collection of clinical information; assesses and evaluates medical and psychiatric information obtained through clinical screening procedure; evaluates discharge planning activities for clients requiring transfers from nursing facilities; plans for utilization of community and hospital resources required by these clients; reviews and implements budget for Clinical Systems Analysis Unit of department; plans, develops and implements training programs for department and other state agency staff; performs related duties as required.
WORKERS COMPENSATION: Reviews, audits, monitors and directs in areas of medical management, cost containment, peer review and rehabilitation; monitors agency and third party administrators and medical community to develop effective programs in medical management and loss control; analyzes medical and physician charges and renders decisions regarding rehabilitative planning for assigned cases; evaluates personal injuries in terms of physical disability and incurred costs as result of medical bills, wage replacement or vocational rehabilitation; develops cost effective plans to return injured workers to employment; identifies and evaluates factors within claimant home; work environment or medical care center that would promote recovery or give cause to unnecessary extended disability; develops plans of cost effective means of treatment and rehabilitation to return injured workers to maximum functioning capacities; coordinates efforts of physicians, employers, employees and rehabilitation counselors; monitors medical bill costs and evaluates need for billed services; monitors and assists in management of lifetime care of catastrophically injured claimant; performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
ALL PARENTHETICALS: Considerable knowledge of relevant State and Federal laws, statutes and regulations; considerable knowledge of principles and practices of nursing care administration and education for a variety of specialties with varied settings; considerable knowledge of principles and practices pertinent to community processes; knowledge of State, Federal and local health agencies and programs; knowledge of nursing education and skill in techniques of teaching; considerable interpersonal skills; oral and written communication skills; ability to plan, implement and evaluate programs; ability to collect and analyze data.
GENERAL, EARLY CHILDHOOD, PUBLIC HEALTH: Considerable knowledge of standards of care and service delivery in community based nursing agencies, licensed home health agencies, health care facilities and institutions.
CHILDREN AND FAMILIES: Considerable knowledge of nursing treatment, trends and resources for pediatric health issues.
DEVELOPMENTAL SERVICES: Considerable knowledge of nursing treatments, trends and resources for persons with intellectual disability.
HEALTHCARE ADVOCATE: Considerable knowledge of health insurance and managed care; considerable internal and external insurance appeal processes; knowledge of state insurance law; knowledge of the impact of the federal Employee Retirement Income Security Act (ERISA) on state regulation of insurance; knowledge of medical terminology; knowledge of medical procedures and billing codes.
MENTAL HEALTH AND ADDICTION SERVICES: Considerable knowledge of nursing treatments, trends and resources for the mentally ill.
WORKERS COMPENSATION: Considerable knowledge of State of Connecticut Workers Compensation statutes, rules and regulations; considerable knowledge of care and service delivery to injured workers.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
CHILDREN AND FAMILIES, DEVELOPMENTAL SERVICES, GENERAL, MENTAL HEALTH AND ADDICTION SERVICES, PUBLIC HEALTH: Four (4) years of experience as a professional nurse in a position involving supervision, consultation, education or administration.
EARLY CHILDHOOD: Four (4) years of experience as a professional nurse in a position involving working with children in acute care or a community setting.
HEALTHCARE ADVOCATE: Four (4) years of experience as a professional nurse in a position involving medical/surgical or mental health practices.
WORKERS COMPENSATION: Four (4) years of experience as a professional nurse in a position involving supervision, consultation, education, or administration in rehabilitative nursing with injured workers, including medical review of insurance claims.
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
GENERAL, PUBLIC HEALTH: Two (2) years of the General Experience must have been in a public health nursing program, home health care agency, community health care setting, or in a hospital.
CHILDREN AND FAMILIES: Two (2) years of the general experience must have been in the area of pediatric nursing.
DEVELOPMENTAL SERVICES: Two (2) years of the General Experience must have been in the area nursing for persons with intellectual disability.
EARLY CHILDHOOD: Two (2) years of the general experience must have been in a setting working with infants, children or youth.
HEALTHCARE ADVOCATE: Two (2) years of the General Experience must have been a utilization review nurse or as a nurse working in the health insurance or healthcare industry on insurance coverage activities.
MENTAL HEALTH AND ADDICITON SERVICES: Two (2) years of the General Experience must have been in psychiatric nursing.
MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
1. A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.
2. A Master's degree in health services administration, nursing or public health may be substituted for one (1) additional year of the General Experience.
1. Incumbents in this class must possess and retain a current license as a registered professional nurse in Connecticut.
2. Incumbents in this class may be required to possess certification as an Insurance Rehabilitation Specialist or be eligible for certification as an Insurance Rehabilitation Specialist.
3. Incumbents in this class may be required to travel.
4. Incumbents in this class may be required to possess and retain a valid Motor Vehicle Operator’s license.
1. Administrative capacity shall be interpreted as having managerial responsibility in setting and implementing policies, carrying out program planning, and evaluating and coordinating special projects, etc. in the area specified in the appropriate parenthetical title.
2. Consultative capacity shall be interpreted as the providing of professional expert nursing advice to other than subordinate staff on major programmatic issues in the area specified in the appropriate parenthetical title.
3. Educational capacity shall be interpreted as experience in a full time professional educational position instructing professional nurses in a formalized program or teaching students in an undergraduate or graduate nursing program in the area specified in the appropriate parenthetical title.
4. Supervisory capacity shall be interpreted as the administrative supervision of registered nurses or other professional staff including accountability for hiring, firing, reviewing and evaluating employee performance in the area specified in the appropriate parenthetical title.
JOB CLASS DESIGNATION
(11)-HEALTH PROF (P-1)
This replaces the existing specification for the class of Nurse Consultant in Salary Group HC/FP 28 approved effective September 16, 2016. (Revised to establish a class code for the Department of Children and Families and modify content)