STATE OF CONNECTICUT EXECUTIVE BRANCH JOBS

Utilization Review Nurse (40 Hour)

Office/On-site

Recruitment #240404-5612FP-001

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Introduction



Looking for an exciting opportunity to make a real impact?
Join us and take the next step in your Nursing career!

The Capitol Region Mental Health Center (CRMHC), under the umbrella of the State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is seeking a qualified individual for the position of Utilization Review Nurse (PCN 26806) to join our team. This critical position will help the health, safety and welfare of those we serve. Find out more information on this great opportunity below!

POSITION HIGHLIGHTS:
  • Work Unit: Inpatient Unit
  • Work Schedule: Monday - Friday
  • Work Hours: Full-time, 40 hours per week
  • Work Shift: First shift, 8:00 a.m. - 4:30 p.m.
  • Location: 500 Vine St, Hartford, CT
WHAT WE CAN OFFER YOU:
State of Connecticut employees participate in a competitive comprehensive benefits plan that includes:
  • A Platinum Healthcare Plan, the nation’s best for state employees and dependents, according to a report by Georgetown’s Center on Health Insurance Reform and article by Ellen Andrews, Ph.D
  • Generous paid time off, include 13 paid holidays per calendar year
  • Extensive pension plan and supplemental retirement offerings
  • Retirement healthcare offerings
  • Professional growth and development opportunities
  • State of Connecticut is an eligible Public Service Loan Forgiveness employer, meaning you may be eligible to have qualifying student loans forgiven after 10 years of service. Click here for more information.
  • A healthy work/life balance!
You'd be able to work for a Forbes top company: 'Forbes' State of Connecticut Ranked One of the Best Employers of 2023 - State of CT Receives National Recognition for Offering Job Growth, Competitive Benefits, and Flexible Schedule.

WHAT YOU'LL BE DOING:
  • Being an essential part of our inpatient unit as we seek hospital accreditation with The Joint Commission (TJC) and reimbursement from Medicare and Medicaid.
  • Auditing the medical record, collecting the needed data required to achieve, and maintaining hospital standards for accreditation, billing, and documentation compliance.
  • Reviewing medical records to collect and analyze data, and to ensure compliance with all regulatory agencies.
  • Monitoring client payer source to ensure active entitlements as clients receive inpatient care, and as they prepare to transition to the community.
  • Preparing statistical reports indicating trends and patterns reflecting quality of care.
HEAR FROM OUR OWN STAFF:


MORE ABOUT THE AGENCY AND FACILITIES:

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, operated by the Connecticut Department of Mental Health and Addiction Services, 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.

Selection Plan

FOR ASSISTANCE IN APPLYING:
Please read or watch our Applicant Tips on How to Apply!

FOR THOSE WHO HOLD AN RN LICENSE IN A STATE OTHER THAN CONNECTICUT AND WISH TO APPLY FOR A CONNECTICUT LICENSE, PLEASE:

  1. Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;
  2. Complete a CT DPH online application online (expand the ‘Public Health Practitioners’ grouping, select ‘Registered Nurse’ and then ‘Start’;
  3. Request verification of your out-of-state license(s) electronically through the National Council of State Boards of Nursing’s: Nursys® System. To send verification of your license(s) to CT, read and agree to the terms, enter your biographic information, select your license type and select ‘SEARCH’. Review the results and select the ‘Next’ button. Check the box next to ‘Connecticut’ and complete the transaction. Once the transaction is completed, you will receive a confirmation email from Nursys and the verification will be available to the DPH. Note that PA and MI verifications are not provided through Nursys. Please contact those state boards for information on obtaining verification.
To Apply:
  • In order to be considered for this job opening, you must meet the Minimum Qualifications as listed on the job opening. The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.
  • In order to receive educational credits toward qualification for this job posting, the institution must be accredited. If the institution of higher learning is located outside of the U.S., you are responsible for providing documentation from a recognized USA accrediting service which specializes in determining foreign education equivalencies to the recruiter listed on this job posting.
  • You must specify your qualifications on your application. You will be unable to make revisions once you submit your application for this posting to the JobAps system.
  • In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process.
  • 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.
Important Next Step Information for After You Apply:
  • 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.
  • 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.
  • 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.
  • The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
  • Interviews will be limited to candidates whose experience and training most closely meet the requirements of the position. Read through this helpful link to prepare for your interview.
  • Candidates who are offered and accept a position with the State of Connecticut are bound by the State Code of Ethics for Public Officials and State Employees which is available at www.ct.gov/ethics.
  • For current state employees, salary calculations are not necessarily comparable from one of the three branches of state government (i.e., Executive, Legislative, Judicial) to the other.
Connect With Us:
  • Due to the large volume of applications received, we are unable to provide confirmation of receipt or status during the recruitment process.
  • Updates will be available through your JobAps portal account. If you have any questions pertaining to this recruitment please contact Joseph K. Fried at Joseph.Fried@ct.gov, 860-924-7053.

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 in-service training; 
  • Maintains up to date knowledge of all changes in relevant discipline; 
  • Monitors personal injuries and medical costs to evaluate need for services billed for appropriate injuries; 
  • May monitor agency and third party administrator files to oversee contractor handling; 
  • 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; 
    • standards of practice of medicine and nursing as well as other health care disciplines; 
    • regulations and standards pertaining to utilization review; 
    • care and service delivery to injured workers; 
  • Skills
    • 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 of 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

  • Experience in quality assurance programs and requirements.
  • Experience in data collection and analysis, and the ability to use the data to impact change.
  • Experience in coordinating and applying for client entitlements.

SPECIAL REQUIREMENTS

  • Incumbents in this class must possess and retain a license as a Registered Professional Nurse in Connecticut.
  • 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.

ACKNOWLEDGEMENT

As defined by Sec. 5-196 of the Connecticut General Statutes, a job class is a position or group of positions that share general characteristics and are categorized under a single title for administrative purposes.  As such, a job class is not meant to be all-inclusive of every task and/or responsibility.




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