Utilization Review Nurse Coordinator (40 Hour) Office / On-site #250924-5613FP-001

Utilization Review Nurse Coordinator (Regulatory)

Full-time, 80-hour program located at the North Region Regional Directors Office, East Hartford, CT. Regular work schedule is Monday to Friday, 8 : 00 a.m. to 4 : 30 p.m. The position requires travel and flexibility to meet the demands of the program.

Responsibilities

• Coordinate workflow and determine priorities to assure highest quality of care with efficient utilization of available services.
• Schedule, assign, oversee and review work.
• Establish and maintain program protocols and procedures.
• Provide staff training and assistance.
• Conduct or assist in conducting performance evaluations.
• Act as liaison with other operating units, agencies and outside officials regarding program policies and procedures.
• Prepare reports and correspondence.
• Assess, evaluate and monitor documentation of all hospital disciplines when performing case reviews.
• Attend professional workshops, seminars and in-service training.
• May supervise Utilization Review Nurses and other staff engaged in review of medical records to maximize Medicare Part B reimbursement.
• May review medical records and compile documents for case presentations.
• May provide pre-certification for and coordinate 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.
• Perform related duties as required.

Minimum Qualifications – General Experience

Minimum Qualifications – Special Experience

Minimum Qualifications – Substitutions Allowed

Preferred Qualifications

Special Requirements

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.

EEO Statement

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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