STATE OF CONNECTICUT EXECUTIVE BRANCH JOBS

Utilization Review Nurse Coordinator (40 Hour)

Office/On-Site

Recruitment #220505-5613FP-001

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Introduction


Are looking for your next step in healthcare?  Do you have experience processing Minimum Data sheets for a Skilled Nursing Facility?  If so, please apply today!  

The State of Connecticut, Department of Veterans Affairs (DVA), is looking for a Utilization Review Nurse Coordinator to support their Skilled Nursing Facility located in Rocky Hill, CT.  This position is full-time, 40 hours weekly. The work schedule is 1st shift, 6:45 a.m. to 3:15 p.m., Monday through Friday. 

For over 140 years, Connecticut has been caring for its Veterans and their dependents. As a Department, we believe in "serving those who have served". This is accomplished through our: Office of Advocacy and Assistance, Residential Facility, Healthcare Center, and Cemetery and Burial Services. 

You will be serving those who have served at the Sgt. John L. Levitow Healthcare Center, a Skilled Nursing Facility licensed by the Connecticut Department of Public Health and certified by the Federal Department of Health and Human Services Centers for Medicare and Medicaid Services. The Healthcare Center (HCC) is also certified as a State Veterans Home by the Federal Veterans Administration and regularly inspected by the VA.  At our health care facility, we provide both short and long-term care for patients requiring daily medical management. 

THIS CAN INCLUDE: 

  • Cancer 
  • Cardiac Disease 
  • Chronic Obstructive Pulmonary Disease 
  • Dementia 
  • Diabetes 
  • End Stage Renal Disease 
  • Hypertension
  • Parkinson's Disease 
  • Stroke
When you walk through the doors of the Healthcare Center (HCC), one immediately feels a sense of community, comfort, and camaraderie. The HCC stands apart from other 24-hour care centers with full-time Physicians and Advanced Practice Registered Nurses on staff.  Our highly trained staff is dedicated to providing compassionate care to meet the unique needs of Veteran patients; built on the foundation of integrity, honor, and respect. We pride ourselves on fostering these qualities as we honor Veteran patients for their service and encourage the innate bond between them. 

We participate in a competitive benefits plan that includes healthcare coverage, a retirement plan as well as paid time off. We encourage a healthy work-life balance! 

Interested in knowing more about becoming a State of Connecticut employee, check out the video below!

Selection Plan

This position may be subject to Federal requirements for COVID 19 Vaccination Immunization.

Candidates who meet the Minimum Qualifications, as listed on the job opening, will be considered for this role, as determined by qualifications stated on the submitted application.  

The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified. 

The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class. 

All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period.  It is the candidate’s obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception.  Requests should be made to DAS.SHRM@ct.gov. 

This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. 

This posting may require completion of additional referral questions (RQs). You can access these RQs via an email that will be sent to you after the posting's closing date or by visiting your JobAps Personal Status Board (Certification Questionnaires section). Your responses to these RQs must be submitted by the question's expiration date. Please regularly check your email and JobAps Personal Status Board for notifications. Please check your SPAM and/or Junk folders on a daily basis in the event an email provider places auto-notification emails in a user's spam. 

Although applicants will receive correspondence via email, as a backup they are also encouraged to sign on to their Personal Status Board on a daily basis to monitor their status, view all emailed notices and complete tasks required in the recruitment process. 

Due to the volume of applications anticipated, we are unable to provide confirmation of receipt or status during the recruitment process. Updates will be provided through your JobAps portal account. 

In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process. 

Note:  At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position. These documents may include:  a cover letter, resume, transcripts, diplomas, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency.  Applicants must meet the minimum qualifications as indicated to apply for this position. 

Should you have questions pertaining to this recruitment, please contact Doreen Clemson at Doreen.Clemson@ct.gov or (860) 785-9855.  

PURPOSE OF JOB CLASS (NATURE OF WORK)

In a state agency this class is accountable for coordinating a utilization review program which promotes effective cost recovery, quality of care and/or compliance with relevant federal and state laws, regulations and standards.

In the Office of Protection and Advocacy and the Department of Developmental Services this class is accountable for performing investigations of abuse, neglect and death in individuals with intellectual disabilities including individuals under the care of the Department of Developmental Services.

EXAMPLES OF DUTIES

WORKING LEAD (REGULATORY) : Coordinates work flow and determines priorities to assure highest quality of care with efficient utilization of available services; 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; acts as liaison with other operating units, agencies and outside officials regarding program policies and procedures; prepares reports and correspondence; assesses, evaluates and monitors documentation of all hospital disciplines when performing case reviews; attends professional workshops, seminars and in-service training; may supervise Utilization Review Nurses and other staff engaged in review of medical records of individuals in state health care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; may review medical records and compile documents for case presentations; may provide pre-certification for and coordination of inmates admitted to and discharged from acute care facilities; may lead an inspection team in IPR/UR and licensing review functions; may conduct entrance and exit interviews of care providers; may supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals on behalf of a facility relative to intermediate denials; may testify in court; may coordinate review and audit of occupational injury and/or disease disability cases for purpose of determining medical management, cost containment, peer review and rehabilitation; may notify acute care hospitals of scheduled utilization review including conducting second level review of cases and case referral to a physician consultant for final disposition; performs related duties as required.

ADVANCED WORKING LEVEL (INVESTIGATORY): Conducts complex investigations into allegations of abuse or neglect of individuals with intellectual disabilities; conducts complex investigations into cases where a death has resulted of an individual with  intellectual disability  for whom the Department of Developmental Services has direct or oversight responsibility for medical care; reviews medical care that was provided to individuals; assists in the investigation to determine if the death is a result of abuse or neglect; participates in the reviews of events, overall care, quality of life and medical care preceding a death; works cooperatively with State and local police, State's Attorneys and other protective services organizations; interviews alleged victims, direct care providers, families and other potential witnesses; prepares comprehensive, complex investigative reports; may provide information and assistance to the Independent Mortality Review Board or Fatality Review Board for Persons with Disabilities; maintains records and documentation; reviews medical records for pertinent information related to investigations; may testify in court proceeding; performs related duties as required.

DEPARTMENT OF VETERANS AFFAIRS: Coordinates activities of care team, plans and schedules meetings, tracks input and attendance; insures outcome of process is accurate document for care planning; audits process according to utilization guidelines and ensures process is completed within appropriate regulatory time frames; trains all Health Care Team members on Resident Assessment Instrument (RAI) care planning system; acts as resource to all areas involved in Minimum Data Set (MDS) process; ensures compliance with state statutes, federal Veterans Affairs regulations and state Department of Veterans Affairs policies and procedures; monitors and manages timely electronic transmission of MDS program data; routinely conducts chart audits and maintains log of deficiencies and discrepancies; identifies errors in coding of MDS and RAI forms during completion process; communicates to leadership and interdisciplinary team members any changes to directives and guidelines; enters MDS data into information system; assures ongoing record documentation supports MDS and RAI coding; develops plan of action to correct identified quality deficiencies; performs related duties as required.

KNOWLEDGE, SKILL AND ABILITY

Considerable knowledge of principles, practices and current trends of nursing; considerable knowledge of standards of medical care; considerable interpersonal skills; considerable oral and written communication skills; considerable ability to analyze individual profiles and progress charts; some supervisory ability.

REGULATORY: Considerable knowledge of and ability to apply relevant state and federal laws, statutes and regulations; considerable knowledge of regulations and standards pertaining to utilization review; considerable knowledge of care and service delivery to injured workers.

INVESTIGATORY: Considerable knowledge of statutes, policies and procedures governing the care and treatment of individuals with intellectual disabilities; considerable knowledge of problems and needs of individuals with  intellectual disabilities; considerable knowledge of various types of residential placement facilities; knowledge of investigatory methods and techniques; considerable interviewing skills; ability to research and analyze data; considerable skills in the preparation of extensive written reports.

DEPARTMENT OF VETERANS AFFAIRS: Knowledge of Minimum Data Set process in a long term care setting and coordination of an interdisciplinary team; ability to utilize computer software.

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

Five (5) years of experience as a registered professional nurse.

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

REGULATORY: Two (2) years of the General Experience must have been in the assessment of the quality and propriety of health care services as required by JCAH and/or Medicare and Medicaid standards and regulations at the level of Utilization Review Nurse.

INVESTIGATORY: Two (2) years of the General Experience must have been working with persons with Behavioral Health or Intellectual Disabilities.

DEPARTMENT OF VETERANS AFFAIRS: Two (2) years of the General Experience must have been in the review and assessment of individuals in a long term care setting.

MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED

A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.

PREFERRED QUALIFICATIONS

Our preferred candidate will possess the following:

  • Experience working in a Skilled Nursing Facility. 
  • Experience processing MDS (Minimum Data Set) documents for Skilled Nursing Facility patients. 
  • Experience clinically qualifying Skilled Nursing Facility patients for Medicare Part A.
  • Experience in the oversight of QAPI (Quality Assurance Performance Improvement) Program. 
  • Experience writing care plans for patients in a Skilled Nursing Facility. 
  • Experience with completing required Medicare A Skilled Nursing Facility forms.

SPECIAL REQUIREMENTS

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 travel.

Conclusion

AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.



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