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

Introduction

The State of Connecticut, Department of Children and Families (DCF) – Albert J. Solnit Children’s Center, South Campus Hospital –is accepting applications for one (1) full-time Utilization Review Nurse Coordinator position, in Middletown, CT.

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 Registered Professional Nurse for the state of Connecticut!  We encourage you to apply today!

Position Highlights: PCN 96219

• Full-time | 1st shift
• Monday – Friday | 8:00 am – 4:30 pm

What we can offer you:

• View our newState Employee Benefits Overview page!
• Professional growth and paid professional development opportunities.
• A healthy work-life balance to all employees!
• 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.
• 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.  Click here for more information.

In your role as a Utilization Review Nurse Coordinator, you will have the opportunity to:

• Coordinate workflow and determine priorities to assure the delivery of the 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
• 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
• Perform related duties as required.
• For a more comprehensive list of duties click here.

About the Albert J. Solnit Children’s Center – South Campus:

At the Albert J. Solnit Children’s Center, we treat our youth and each other with dignity and respect.  It is in this relational, cultural and gender sensitive surrounding that our therapeutic milieu is based.  Interdisciplinary teams develop, implement and continually assess individualized treatment plans.

Solnit – South Campus is a state-administered Psychiatric facility for Connecticut’s youth who are under the age of eighteen, located on a 67-acre campus overlooking the Connecticut River in Middletown, CT.  The campus includes four coed hospital units and three female adolescent Psychiatric Residential Treatment Facility (PRTF) cottages.  The Utilization Review Nurse Coordinator position is located at Solnit Hospital.  The Solnit Hospital provides comprehensive care to children and adolescents with severe mental illness and related behavior and emotional problems who cannot be safely assessed or treated in a less restrictive setting.

The campus includes: Four coed hospital units, three female adolescent Psychiatric Residential Treatment Facility cottages (PRTF), two schools, an indoor pool, playgrounds, ball field, two gyms, recreation rooms, and outdoor picnic area.

About the State of Connecticut:

Living in Connecticut allows you to live with mountains, forests, ocean fronts, rivers, and a wonderful green countryside right at your doorstep.  The state has charm, elegance, and a high standard of living.  Our school systems offer an outstanding education, and our communities are among the safest in the country.  Connecticut experiences all four seasons and gives you the option to choose living in sophisticated country-life or living in the center of a lively city.

We encourage you to come see all that Connecticut has to offer by joining the DCF team!

Selection Plan

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 (expand the ‘Public Health Practitioners’ grouping, select ‘Registered Nurse’ and then ‘Start’;
• Request verification of 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.

FOR ASSISTANCE WITH 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 this job opening.  You must specify your qualifications on your application.
• For current state employees, salary calculations are not necessarily comparable from one of the three branches of government (i.e., Executive, Legislative, Judicial) to the other.
• The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.
• These positions will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion, and merit employment rules.  Applications to this recruitment will be used to meet collective bargaining requirements.  Once any collective bargaining requirements have been met, all other applications may be considered.
• Interviews will be limited to candidates whose experience most closely meets the preferred qualifications, so please ensure that your application is complete and details your experience as outlined in this job posting.  Please note: You will be unable to make revisions once you submit your application into the JobAps system.
• The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
• Ensure that your application is complete and detailed before submitting it. In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process. You will not be able to make revisions once your application is submitted into the JobAps system.

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.
• 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, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency. Applicants must meet the minimum qualifications as indicated to apply for this position.
• 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.
• Due to the large volume of applications received, the Department of Administrative Services is unable to provide confirmation of receipt or status during the recruitment process. Updates will be available through your JobAps portal account.
• Revised Master Application Tutorial: Click Here
• Read through this helpful link to prepare for your interview.

Connect With Us:

• If you have any questions pertaining to this recruitment, please contact Rocky Young at rocky.young@ct.gov and reference the recruitment number. 
• Follow the State of Connecticut on LinkedIn.

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.

In the Department of Developmental Services this class is accountable for performing investigations of abuse, neglect and death in individuals with an intellectual disability including individuals under the care of the Department of Developmental Services.

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.

ADVANCED WORKING LEVEL (INVESTIGATORY):

• Conducts complex investigations into allegations of abuse or neglect of individuals with an intellectual disability;
• Conducts complex investigations into cases where a death has resulted of an individual with an intellectual disability for whom the Department of Developmental Services has direct or oversight responsibility for medical care;
• Reviews medical care that was provided to individuals;
• Assists in the investigation to determine if the death is a result of abuse or neglect;
• Participates in the reviews of events, overall care, quality of life and medical care preceding a death;
• Works cooperatively with State and local police, State's Attorneys and other protective services organizations;
• Interviews alleged victims, direct care providers, families and other potential witnesses;
• Prepares comprehensive, complex investigative reports;
• Maintains records and documentation;
• Reviews medical records for pertinent information related to investigations;
• May provide information and assistance to the Independent Mortality Review Board or Fatality Review Board for Persons with Disabilities;
• May testify in court proceeding;
• Performs related duties as required.

DEPARTMENT OF VETERANS AFFAIRS:

• Coordinates activities of care team, plans and schedules meetings, tracks input and attendance;
• Ensures outcome of process is accurate document for care planning;
• Audits process according to utilization guidelines and ensures process is completed within appropriate regulatory time frames;
• Trains all Health Care Team members on Resident Assessment Instrument (RAI) care planning system;
• Acts as resource to all areas involved in Minimum Data Set (MDS) process;
• Ensures compliance with state statutes, federal Veterans Affairs regulations and state Department of Veterans Affairs policies and procedures;
• Monitors and manages timely electronic transmission of MDS program data;
• Routinely conducts chart audits and maintains log of deficiencies and discrepancies;
• Identifies errors in coding of MDS and RAI forms during completion process;
• Communicates to leadership and interdisciplinary team members any changes to directives and guidelines;
• Enters MDS data into information system;
• Assures ongoing record documentation supports MDS and RAI coding;
• Develops plan of action to correct identified quality deficiencies;
• 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.

INVESTIGATORY:

• Considerable knowledge of
  • statutes, policies and procedures governing the care and treatment of individuals with an intellectual disability;
  • problems and needs of individuals with an intellectual disability;
  • various types of residential placement facilities;
• Knowledge of investigatory methods and techniques;
• Considerable
  • interviewing skills;
  • skills in the preparation of extensive written reports;
• Ability to research and analyze data.

DEPARTMENT OF VETERANS AFFAIRS:

• Knowledge of Minimum Data Set process in a long-term care setting and coordination of an interdisciplinary team;
• Ability to utilize computer software.

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.

INVESTIGATORY: Two (2) years of the General Experience must have been working with persons with behavioral health disabilities or an intellectual disability.

DEPARTMENT OF VETERANS AFFAIRS: Two (2) years of the General Experience must have been in the review and assessment of individuals in a long-term care setting.

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 Data Collection, analysis, and presentation
• Intermediate to advanced skills in creating spreadsheets and utilizing data to create charts and graphs.
• Experience with the Joint Commission's accreditation standards for hospital. 
• Experience with Medicare & Medicaid Regulatory requirements and private insurances as it relates to utilization review/management and quality of care.
• 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.

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.