Connecticut StateDepartment of Administrative Services

Utilization Review Nurse (40 Hour)

Recruitment #210715-5612FP-001

Introduction


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.

Capitol Region Mental Health Center (CRMHC) is a community based mental health center which provides an array of innovative clinical and community support services to individuals with a psychiatric disability, in many cases with co-occurring problems of substance abuse. CRMHC also collaborates with the Greater Hartford DMHAS-Funded Mental Health Programs that is comprised of 15 non-profit agencies located in Hartford and West Hartford. These agencies work together to provide a comprehensive array of behavioral health services to nearly 3300 individuals and families. We serve adults with serious psychiatric disabilities or the co-occurring disorders of psychiatric illness and substance use, 18 years and older who reside in Hartford (Catchment Area 23), West Hartford, Farmington, Avon, Canton and Simsbury (Catchment Are 18). Our mission is to partner with persons in recovery to ensure access to high quality and culturally competent person-centered behavioral healthcare services.

Are you looking for a challenging position utilizing your Nursing know-how? If so, please apply to our Utilization Review Nurse opening! We currently seek qualified individuals for the position of Utilization Review Nurse (PCN: 26924) within Quality Improvement. This position is full-time, 40 hours and is 1st shift. The schedule is Monday-Friday working 8:00am to 4:30pm. We are located at 500 Vine Street, Hartford, CT 06112.

Discovery the opportunity to:
  • Participate in the Quality Improvement (QI) program at the agency;
  • Review/coordinate all incident reports;
  • Establish current care authorizations as well as coordinating Medicare screening reports;
  • Participate in QI division documentation review activities;
  • Assists in the review of treatment notes, case management notes, as well as, medical Evaluation and Monitoring (E&M) documentation.

We participate in a competitive benefits plan that includes healthcare coverage, a retirement plan, as well as, paid time off! We offer outstanding work/life balance and limitless opportunity.

Selection Plan

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

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.

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 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.

Interviews will be limited to candidates whose experience most closely meet the preferred requirements of the position. Applicants invited to interview may be required to submit additional documentation, which supports their qualification(s) for this position. These documents may include: performance reviews, supervisory references, college transcripts, licensure, etc., at the discretion of the hiring agency.

Please Note: You will be unable to make revisions once you submit your application for this posting to the JobAps system.

Should you have questions regarding this recruitment please contact Andrew Pebley at Andrew.Pebley@ct.gov or (860) 785-6185.

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.

PREFERRED QUALIFICATIONS

Our preferred candidate will have:
  • Experience providing high quality review of medical and non-medical documentation in the context of behavioral health care delivery;
  • Experience with utilization review and submission of reimbursement data;
  • Experience using electronic health record systems as well as accessing paper client chart information;
  • Experience with use of current office systems such as Microsoft Excel, Microsoft Teams, Office 365 suite, and voice/video to communicate with agency staff;
  • Experience identifying risk issues and determining critical areas that need immediate attention through the use of data reporting as well as creating new reporting processes.

SPECIAL REQUIREMENTS

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.

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.







The State of Connecticut is an Affirmative Action/Equal Opportunity Employer and strongly encourages the application of women, minorities and persons with disabilities.