Utilization Review Nurse (35 Hour)

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 opportunity to: 

• 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 
• Work 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 application.  

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

The 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. 

This 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 your application.  

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

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.

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.

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.

Three (3) years experience as a registered professional nurse.

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.

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

Our ideal 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 documentation practices.  

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.