Registered Nurse (RN) - Utilization Review
Connecticut Valley Hospital
Middletown, CT

Utilization Review Nurse Coordinator (40 Hour) (Office/On-Site) - #240516-5613FP-001

Introduction Are you a Registered Nurse looking for an opportunity to make a difference in the public sector? If so, read below and apply today! ABOUT US: 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. THE POSITION: We are currently seeking a Utilization Review Nurse Coordinator to join our team. POSITION HIGHLIGHTS * SCHEDULE: Full-Time (40 Hours), Monday - Friday, First Shift (8:00 A.M. - 4:30 P.M.) * FACILITY: Connecticut Valley Hospital (CVH) * UNIT: ASSD Utilization Management Unit (Administrative Support Services Division) * ADDRESS: 1000 Silver Street, Middletown, CT 06457 * POSITION NUMBER: 25176 WHAT'S IN IT FOR YOU: * The opportunity 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 * 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., along with comprehensive benefit offerings * Extensive pension plan and supplemental retirement offerings * Generous paid time off, including 13 paid holidays per calendar year * Professional growth and development opportunities * A healthy work/life balance to all employees * 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. DISCOVER THE OPPORTUNITY TO: * Be a part of a comprehensive team of caring professionals; * Provide support that is passionate about improving the lives of those we serve; * Assist our clients so they can achieve success; * Make a difference in the public sector; and * Work together in a collaborative team environment. OUR MISSION: Our mission is to partner with persons in recovery to ensure access to high quality and culturally competent person-centered behavioral healthcare services. ABOUT THE UNIT: Admission to the Addiction Services Division (ASD) is facilitated through a Screening and Admissions Unit which operates 24 hours a day, 7 days a week. Admissions are referred from a wide variety of sources, including self-referrals, community addiction and mental health services agencies, hospitals, various court diversion programs, and transfers from within ASD or other CVH divisions. Admission criteria are determined by the DMHAS Connecticut Client Placement Criteria (CCPC), which is derived from the (ASAM) (PPC). Both the detoxification and rehabilitation services represent the most intensive levels of care represented in the CCPC levels of care. As a result, clients admitted to these levels of care tend to have complex needs, including high addiction severity and significant psychiatric, medical, and psychosocial problems. Most clients are admitted on a voluntary status, although many clients are admitted for detoxification under a five day Physician's Emergency Commitment (PEC) status. Many rehabilitation clients are referred from the court system under either a pre- or post-conviction status, with treatment offered as an alternative to incarceration; a few are referred under a civil commitment status. CVH Addiction Services is the statewide designated provider for its levels of care for individuals who are deaf or hard of hearing. Evidence-based practices with an emphasis on gender-specific treatment guide are aspects of care planning. As part of the discharge planning process, clients are assisted in connecting to continuing care and associated community support services, including medication assisted treatment where indication. Start with us. Stay with us. Grow with us. We welcome you to be a part of a comprehensive team of caring professionals and assist our clients/patients so they can achieve success. You will experience the opportunity to make a difference in the public sector as well as Make an ImpaCT as a Head Nurse for the State of Connecticut! We encourage you to apply today! Watch the video below to see what it is like to be a State of Connecticut employee! Selection Plan FOR ASSISTANCE IN APPLYING: Please read or watch our Applicant Tips on How to Apply! Please Note: 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. FOR THOSE WHO HOLD AN RN LICENSE IN A STATE OTHER THAN CONNECTICUT AND WISH TO APPLY FOR A CONNECTICUT LICENSE, PLEASE: * Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license; * Complete a CT DPH online application online (expand the 'Public Health Practitioners' grouping, select 'Registered Nurse' and then 'Start'; * 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. Please Note: 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. 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. * 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 [email protected]. * 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. * 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. 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 Nicole Frascatore via email at [email protected]. * Read through this helpful link to prepare for your interview. PURPOSE OF JOB CLASS (NATURE OF WORK) In a state agency this class is accountable for coordinating a utilization review program which promotes effective cost recovery, quality of care and/or compliance with relevant federal and state laws, regulations and standards. EXAMPLES OF DUTIES WORKING LEAD (REGULATORY): * Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of available services; * Schedules, assigns, oversees and reviews work; * Establishes and maintains program protocols and procedures; * Provides staff training and assistance; * Conducts or assists in conducting performance evaluations; * Acts as liaison with other operating units, agencies and outside officials regarding program policies and procedures; * Prepares reports and correspondence; * Assesses, evaluates and monitors documentation of all hospital disciplines when performing case reviews; * Attends professional workshops, seminars and in-service training; * May supervise Utilization Review Nurses and other staff engaged in review of medical records of individuals in state health care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; * May review medical records and compile documents for case presentations; * May provide pre-certification for and coordination of inmates admitted to and discharged from acute care facilities; * May lead an inspection team in IPR/UR and licensing review functions; * May conduct entrance and exit interviews of care providers; * May supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals on behalf of a facility relative to intermediate denials; * May testify in court; * May coordinate review and audit of occupational injury and/or disease disability cases for purpose of determining medical management, cost containment, peer review and rehabilitation; * May notify acute care hospitals of scheduled utilization review including conducting second level review of cases and case referral to a physician consultant for final disposition; * Performs related duties as required. KNOWLEDGE, SKILL AND ABILITY * Considerable knowledge of * principles, practices and current trends of nursing; * standards of medical care * Considerable * interpersonal skills; * oral and written communication skills; * Considerable ability to analyze individual profiles and progress charts; * Supervisory ability. REGULATORY: * Considerable knowledge of * and ability to apply relevant state and federal laws, statutes and regulations; * regulations and standards pertaining to utilization review; * care and service delivery to injured workers. MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE Five (5) years of experience as a registered professional nurse. MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE REGULATORY: Two (2) years of the General Experience must have been in the assessment of the quality and propriety of health care services as required by Joint Commission on Accreditation of Healthcare Organizations (JCAH) and/or Medicare and Medicaid standards and regulations at the level of Utilization Review Nurse. MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience. PREFERRED QUALIFICATIONS * Experience applying managed care principles to the provision of care. * Experience with Medicare & Medicaid Regulatory Requirements and private insurance as it relates to utilization review/management and quality of care. * Experience using and establishing medical necessity criteria to obtain Initial and Continued Stay Authorizations. * Experience with peer to peer medical/clinical reviews. * Experience with the Managed Care Appeal process. SPECIAL REQUIREMENTS * Incumbents in this class must possess and retain a current 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.