Registered Nurse (RN) - Utilization Review
State of Connecticut
New Haven, CT
days
Sign-On Bonus

Utilization Review Nurse (40 Hour) (Office/On-site) - #240514-5612FP-001

Introduction Are you a skilled Registered Nurse (RN)? Join our team and utilize your expertise to ensure cost-effective quality care. Apply today to make a difference in healthcare delivery! Join the State of Connecticut Department of Mental Health and Addiction Services (DMHAS) as a Utilization Review Nurse! We are recruiting for two qualified and experienced individuals to join our team. Dive into a world of impactful mental healthcare, where your skills and compassion make a difference. Explore the details below and seize the opportunity to be a part of something meaningful! POSITION HIGHLIGHTS: * FACILITY: Connecticut Mental Health Center (CMHC) * LOCATION: Administration Department * ADDRESS: 34 Park Street, New Haven, CT * SCHEDULE: Full-time (40 hours weekly), 1st Shift, Monday - Friday, 8:30 a.m. - 5:00 p.m. * POSITION NUMBERS: 26760 & 102342 WHY THE STATE OF CONNECTICUT: * Join an Award-Winning Team: Be part of the prestigious Forbes-ranked State of Connecticut, recognized as one of the Best Employers of 2023. Experience national acclaim for providing unparalleled job growth, competitive benefits, and flexible schedules. * Platinum Healthcare Excellence: Enjoy the nation's top-rated healthcare plan for state employees and their dependents. Our Platinum Healthcare Plan, ranked the best by Georgetown's Center on Health Insurance Reform and endorsed by Ellen Andrews, Ph.D., ensures comprehensive coverage and well-being for you and your family. * Secure Your Future: Benefit from our robust pension plan and explore supplemental retirement offerings, ensuring a secure and comfortable future for you and your loved ones. * Invest in Your Education and Future: As a Public Service Loan Forgiveness employer, the State of Connecticut supports your educational journey. You may qualify for student loan forgiveness after just 10 years of dedicated service. Learn more here. * Time for What Matters: Embrace a healthy work-life balance with generous paid time off, including 13 paid holidays per calendar year. Prioritize your well-being and make the most of your personal time. * Unlock Your Potential: Grow professionally with a range of development opportunities. The State of Connecticut is committed to nurturing your skills and helping you reach new heights in your career. * Cultivate Balance: We believe in a healthy work/life balance for all our employees. Join us in fostering an environment where your professional and personal lives harmonize, allowing you to thrive in both. DISCOVER THE OPPORTUNITY TO: * Communicate with patients regarding their entitlements (Medicare/Medicaid, private insurance) and ensure all relevant paperwork is signed * Work with DAS billing to ensure maximum revenue for inpatient stays * Monitor length of stay and work with treatment teams on discharge planning * Complete continuous audits/tracers of inpatient documentation in support of Joint Commission standards * Attend treatment team meetings and provide feedback on level of care, discharge planning, etc. MORE ABOUT THE AGENCY AND DIVISION: 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. Start With Us. Stay With Us. Grow With Us. Selection Plan FOR ASSISTANCE IN APPLYING: Please read or watch our Applicant Tips on How to Apply! FOR THOSE WHO HOLD A 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. 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. * 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. 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. * 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. * Read through this helpful link to prepare for your interview. 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 Alyssa Hovanec via email at [email protected]. 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 with inpatient psychiatric hospitalization and discharge focused treatment planning * Experience with Medicare Part B billing requirements * Experience with Medicare/Medicaid and commercial insurances (authorizations, billable services, level of care criteria) * Experience participating within a multidisciplinary treatment team * Experience teaching and providing guidance to providers on how to improve the level of quality in their documentation * Experience with Excel, Word and other programs to collect, analyze and report data 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.