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Utilization Review Nurse (40 Hour) (Office/On-Site)

Company

State of Connecticut - Department of Mental Health & Addiction Services
Address , New Haven, Ct
Employment type FULL_TIME
Salary $74,697 - $101,247 a year
Expires 2023-06-25
Posted at 1 year ago
Job Description
The State of Connecticut Department of Mental Health and Addiction Services (DMHAS) is currently seeking two (2) experienced and qualified individuals for the position of Utilization Review Nurse to join their team!

POSITION HIGHLIGHTS:
  • Work Hours: Full time (40 hours per week), 1st Shift (8:30 a.m. - 5:00 p.m.), Monday through Friday
  • Facility: Connecticut Mental Health Center (CMHC)
  • Unit/Team: Utilization Review Department
  • Location: New Haven, CT
WHAT WE CAN OFFER YOU:
State of Connecticut employees participate in a competitive comprehensive benefits plan that includes:
  • Industry leading health benefits with medical and dental coverage;
  • 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
  • Retirement healthcare offerings;
  • As a loan forgiveness organization, you may be able to qualify for one or more State or Federal loan forgiveness programs;
  • Extensive pension plan and supplemental retirement offerings;
  • A healthy work/life balance!
  • Professional growth and development opportunities; and
  • Generous paid time off, include 13 paid holidays per calendar year;
AS A UTILIZATION REVIEW NURSE YOU WILL:
  • Attend treatment team meetings and provide feedback on level of care, discharge planning, etc.
  • Work with DAS billing to ensure maximum revenue for inpatient stays
  • Complete continuous audits/tracers of inpatient documentation in support of Joint Commission standards
  • Monitor length of stay and work with treatment teams on discharge planning
  • Communicate with patients regarding their entitlements (Medicare/Medicaid, private insurance) and ensure all relevant paperwork is signed
MORE ABOUT THE AGENCY AND FACILITY:
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.

CMHC is an urban community mental health center with an exceptional 50-year tradition of serving individuals with serious mental illness and/or addiction. Founded in 1966, CMHC is a partnership between DHMAS and the Yale Department of Psychiatry. CMHC is nationally recognized for its scientific research into the causes and treatment of mental illness and addiction. The Abraham Ribicoff Research Facilities include multiple research programs in a variety of areas. CMHC is also a major training site for individuals pursuing careers in mental health fields including psychiatry, psychology, social work, nursing and pastoral care.

Selection Plan

FOR ASSISTANCE IN APPLYING:
Please visit our 'Applicant Tips on How to Apply' page.


This position may be subject to Federal requirements for COVID 19 Vaccination Immunization.


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 comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process.
  • This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules.
  • 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.
  • 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 [email protected].
Important Next Step Information for After You Apply:
  • Interviews will be limited to candidates whose experience and training most closely meet the requirements of the position.
  • 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.
  • 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.
  • The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
  • 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.
  • 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.
Connect With Us:
  • Updates will be available through your JobAps portal account. If you have any questions pertaining to this recruitment please contact Alyssa Hovanec via email at [email protected].
  • Due to the large volume of applications received, we are unable to provide confirmation of receipt or status during the recruitment process.

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

  • Experience with inpatient psychiatric hospitalization
  • Experience with chart audits involving inpatient psychiatric documentation
  • Experience with Excel
  • Experience with Medicare/Medicaid and commercial insurances (authorizations, billable services, level of care criteria)
  • Experience participating within a multidisciplinary treatment team
  • Experience with Medicare Part B billing requirements
  • Experience with discharge focused treatment planning

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.