Utilization Review Nurse?/Office?/On-site - FP

Position: Utilization Review Nurse (40 Hour) (Office/On-site) - #250102-5612FP-001

Introduction

Are you a skilled Registered Nurse (RN)? Join our team and utilize your expertise to ensure cost-effective quality care. Apply today 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 for professional growth and development. Embrace a healthy work/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.

Selection Plan

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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.

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.

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 as 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…

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