Utilization Review Nurse Coordinator (37.5 Hour)

The State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) seeks qualified individuals for the position of Utilization Review Nurse Coordinator, POSITION # CV 25176.  This position is located at Connecticut Valley Hospital, Utilization Review Department, Middletown, CT  06457 and will also cover Blue Hills Campus, as needed, which is located in Hartford, CT.  This is a full-time, thirty-seven and one half  (37.50) hours per week position.  The Schedule is as follows:  Monday - Friday:  8:00 a.m. to 4:00 p.m.

Please ensure that your application is complete.  You will be unable to make revisions once you submit your application into the JobAps system.  If selected for further consideration, State Employees may be required to provide their last two (2) Service Ratings and Non-State Employees may be required to provide two (2) Letters of Reference.

Questions regarding this Position should be directed to Deb Robinson, DMHAS HR, (860) 262-5819 or Deborah.A.Robinson@ct.gov.

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.

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 inservice training; may supervise Utilization Review Nurses and other staff engaged in review of medical records of patients and/or clients in state health care institutions 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.

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 patient 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.

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

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.

A Bachelor's degree in nursing may be substituted for one (1) 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 will be required to travel.

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.