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

Introduction

Are you a skilled Registered Nurse (RN)?

Join our team and utilize your expertise to ensure cost-effective quality care.

Apply today and make a difference in healthcare delivery!

Join the State of Connecticut Department of Mental Health and Addiction Services (DMHAS) as a Utilization Review Nurse! Bring your skills and compassion to a team dedicated to making a difference in mental health care. Explore the details below and take the next step in your meaningful career!

POSITION HIGHLIGHTS:

• FACILITY: Capitol Region Mental Health Center (CRMHC)
• LOCATION: Quality Improvement Department
• ADDRESS: Hartford, CT
• SCHEDULE: Full-time (40 hours weekly), Monday - Friday, 8:00 a.m. - 4:30 p.m.
• POSITION NUMBER: 99906

WHY THE STATE OF CONNECTICUT:

• Explore our comprehensive State Employee Benefits Overview to see what we offer
• 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.
• Enjoy endless opportunities forprofessional growth and development
• Embrace a healthywork/life balance tailored to all employees

IN THIS ROLE YOU WILL:

• Serve as a key member of the Quality Improvement Department, leveraging experience and skills to review clinical documentation.
• Support the department's reimbursement activities for clinical services.
• Collaborate with the team to ensure clinical intakes, psychosocial assessments, and risk evaluations meet high standards.
• Consider and document all relevant factors, including medical history, current symptomatology, family history, substance use, medical concerns, trauma, relational history, vocational or legal issues

ABOUT US:

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.

MORE ABOUT THE FACILITY:

CRMHC is a community based mental health center serving Hartford, West Hartford, Farmington, Avon, Canton and Simsbury providing individuals with behavioral health services. CRMHC collaborates with the greater Hartford DMHAS-Funded mental health programs comprising 15 non-profit agencies located in Hartford and West Hartford.  These agencies work together to provide a comprehensive array of behavioral health services to adults with serious psychiatric disabilities as well as co-occurring psychiatric illness and substance use. 

Please note:

• A comprehensive medical examination, including a drug screening, will be required of all applicants upon a conditional offer of employment.
• All state employees must adhere to Connecticut’s Policy for a Drug Free Workplace. 

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!


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 DAS.SHRM@ct.gov.
• 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 and/or phone, 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 Alyssa.Hovanec@ct.gov.

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 reviewing and auditing services to clients experiencing chronic and persistent mental illness
• Experience teaching and providing guidance to providers on how to improve the level of quality in their documentation
• Experience integrating evidence-based treatment into mental health service delivery
• Experience working with and creating Microsoft Excel spreadsheets, including managing data, formatting, and setting up formulas

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.