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

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

State of ConnecticutEast Hartford, CT, US
9 hours ago
Job type
  • Full-time
Job description

The State of Connecticut, Department of Developmental Services (DDS) – North Region - is accepting applications for a full-time Utilization Review Nurse Coordinator (Regulatory) position, located at North Region Regional Directors Office, East Hartford, CT.

POSITION HIGHLIGHTS

  • Full Time, 80-HR / Biweekly
  • Schedule : Monday – Friday : 8 : 00am – 4 : 30pm
  • Regular Days Off : Saturday, Sunday
  • Location : North Region Regional Directors Office, East Hartford
  • Work schedule flexibility is required to meet the demands of the position

Please Note :

  • Incumbents will be required to travel.

    • What We Can Offer You

  • Visit our State Employee Benefits Overview page!
  • Professional growth and development opportunities.
  • A healthy work / life balance to all employees.
  • The 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.

    • DUTIES

    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

  • 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;
  • Considerable knowledge of standards of medical care
  • Considerable interpersonal skills;
  • Considerable oral and written communication skills;
  • Considerable ability to analyze individual profiles and progress charts;
  • Supervisory ability.

    • MINIMUM QUALIFICATIONS

  • Five (5) years of experience as a Registered Nurse.
  • 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.

    • PREFERRED QUALIFICATIONS

  • Experience working with individuals with intellectual and developmental disabilities, assessing their medical and behavioral needs across the life span.
  • Experience with discharge planning from hospitals or Skilled Nursing facilities, to family or own homes.
  • Experience providing nursing oversight regarding the Omnibus Budget Reconciliation Act (OBRA).
  • Experience coordinating with Private Agency Providers, Skilled nursing Facilities.
  • Experience with current Department of Developmental Services Nursing Policies, Procedures, and Regulations and mortality review process.
  • Experience in a supervisory role.
  • Experience auditing charts for quality assurance compliance.
  • Experience using Microsoft applications, including Outlook, Excel, Teams, and Word.

    • SPECIAL REQUIREMENTS

  • Incumbents in this class must possess and retain a current license as a Registered Nurse in Connecticut.
  • Incumbents in this class may be required to travel.

    • The State of Connecticut is an equal opportunity / affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.

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    Utilization Review Nurse • East Hartford, CT, US

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