Our mission at the State of Connecticut, Department of Mental Health and Addiction Services (DMHAS), is a
health care agency whose mission is to promote the overall health and wellness
of persons with behavioral health needs through an integrated network of
holistic, comprehensive, effective, and efficient services and supports that
foster dignity, respect, and self-sufficiency in those we serve.
Do you want to
make a difference while participating in a dynamic and reciprocal health care
environment in the public sector? If so, we have an excellent opportunity
for you to join our hospital’s team!
The DMHAS, Southeastern Mental Health
Authority (SMHA) seeks a qualified individual for the position of Utilization
Review Nurse. This position is within the Quality Management Division located at 401 West Thames Street, Norwich, CT. This is a full-time, 35
hours per week position. The work schedule is 1st shift, 8:00 a.m. to 3:30 p.m., Monday through Friday. The position number is 114473.
SMHA is a community mental health
agency operated by DMHAS. Its primary goal is to provide high quality behavioral
health services to those in our community with mental health and substance use
disorders who are 18 years or older and reside in New London County and its
surrounding towns. Services, which include case management, outpatient
behavioral health, crisis intervention, respite care, and forensic services,
are recovery oriented and offered in a trauma informed and culturally sensitive
manner. We support individuals to identify and achieve their own goals in
recovery, fostering independence, dignity, and ability.
You will discover the
- Provide support to a division that is passionate about
improving the lives of those we serve;
- Audit charts and services related to
billing for quality and content;
- Develop summary reports;
- Provide ongoing education
to program staff related to billing, services and documentation; and
together in a collaborative team environment.
In order to be considered for this
job opening, you must be a current State of CT employee, who has permanent
state status* and meet the Minimum Qualifications as listed on the job
opening. You must specify your qualifications on your application.
*For employees in the classified service, permanent status is obtained after
successful completion of a working test period. For employees in the
unclassified service, permanent status is obtained after serving in a position
for at least six months (full-time or full-time equivalent).
This position will
be filled in accordance with contractual language, reemployment, SEBAC,
transfer, promotion and merit employment rules. 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
The immediate vacancy is listed above, however, applications
to this recruitment may be used for future vacancies in this job class.
minimum experience and training requirements must be met by the close date on
the job opening, unless otherwise specified.
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.
posting may require completion of additional referral questions (RQs) which
will be sent to you via email after the closing date. The email notification
will include an expiration date by which you must submit (Finish) your
responses. Please regularly check your email for notifications. Please check
your SPAM and/or Junk folders, as emails could end up there in error.
Please ensure that your application is complete and you have included your
resume in the “Resume Tab” of your application as you will be unable to make
revisions once you submit your application into the JobAps system. Individuals
considered for interview will be required to submit additional documentation
supporting their qualification(s) for this position. These documents may
include performance reviews, attendance, supervisory references, college
transcripts, licensure, etc. You do not have to attach these documents to
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 a full range of duties involving the assessment and review of health care delivery systems or medical cost containment activities and programs related to agency efforts to promote cost effective quality of care of cost containment in accordance with various federal and/or state statutes, regulations and guidelines.
EXAMPLES OF DUTIES
Performs a variety of duties related to review of various types of health and medical care delivery and reimbursement systems; participates in utilization review and/or quality assurance programs; conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation; summarizes and analyzes data; prepares statistical reports; implements decisions in program according to revisions in standards; attends professional workshops, seminars and inservice training; maintains up to date knowledge of all changes in relevant discipline; may monitor agency and third party administrator files to oversee contractor handling; monitors personal injuries and medical costs to evaluate need for services billed for appropriate injuries; may review medical records of various health care eligibility, resource unit referral and/or compliance with federal funding provisions; performs related duties are required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of principles, practices and current trends in nursing; knowledge of and ability to apply relevant state and federal laws, statutes and regulations; knowledge of standards of practice of medicine and nursing as well as other health care disciplines; knowledge of regulations and standards pertaining to utilization review; knowledge of care and service delivery to injured workers; interpersonal skills; oral and written communication skills; ability to analyze patient profile and progress charts to evaluate proper care and treatment.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
Three (3) years experience as a registered professional nurse.
MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE
One (1) year of the General Experience must have been in hospital or institutional nursing, in a medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims.
MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.
candidate will possess the following:
- Experience interpreting and applying
insurance/billing guidelines to the auditing process;
- Experience using Word and
Excel computer programs to collect, analyze data and prepare statistical
reports using charts, graphs, etc.; and
- Experience educating staff on
1. Incumbents in this class must possess and retain a license as a registered
professional nurse in Connecticut.
2. Incumbents in this class may 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.