Utilization Review Nurse Coordinator (40 Hour)

Office/On-site

Recruitment # 250210-5613FP-001

Location Middletown, CT

Date Opened 2/25/2025 12:00:00 AM

Salary $86,261 - $116,571/year

Job Type Open to the Public

Close Date 3/4/2025 11:59:00 PM

Go Back Apply View Benefits (https://www.jobapscloud.com/CT/jobs/?b=Benefits)

• Introduction

The State of Connecticut (https://portal.ct.gov/) , Department of Children and Families (DCF (https://portal.ct.gov/dcf) ) – Albert J. Solnit Children’s Center, South Campus Hospital (https://portal.ct.gov/dcf/solnit-center/south) – is accepting applications for two (2) Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) positions, located in Middletown, CT.

Position Highlights:

• PCN 96219, 44750

• Full-time, 40 hours per week

• First (1st) shift

• Monday – Friday

• 8:00 a.m. - 4:30 p.m.

• Middletown, CT

The Role:

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!

About Us:

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 (https://portal.ct.gov/dcf/solnit-center/south) 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.

What’s In It For You:

Visit our new State Employee Benefits Overview (https://www.jobapscloud.com/CT/jobs/?b=Benefits) page!

• Work at a Forbes-recognized company! Connecticut is proud to be featured on both America's Best Employers by State and Best Employers for New Grads in 2024. With our dynamic job market and commitment to fostering a thriving workforce, Connecticut stands out as a top destination for both seasoned professionals and fresh graduates seeking to launch their careers.

• Professional growth and paid professional development opportunities.

• A healthy work-life balance (https://www.youtube.com/watch?v=y6n9M1Qd5fo) to all employees.

• State of Connecticut is an eligible Public Service Loan Forgiveness employer, meaning you may be eligible to have qualifying student loan forgiveness after 10 years of service. Click here (https://studentaid.gov/manage-loans/forgiveness-cancellation/public-service) for more information.

Discover the opportunity to:

• Engage in a rewarding career

• Assist our employees so they can achieve success

• Make a difference in the public sector

• Work together in a collaborative team environment

  Selection Plan

  FOR THOSE WHO HOLD A RN LICENSE IN A STATE OTHER THAN CONNECTICUT AND WISH TO APPLY FOR A CONNECTICUT LICENSE, PLEASE:

• Review the eligibility and documentation requirements (https://portal.ct.gov/DPH/Practitioner-Licensing--Investigations/Registered-Nurse/RN-Licensure-by-Endorsement) for CT license by endorsement of an out-of-state license;

• Complete a CT DPH online application (https://www.elicense.ct.gov/) online (expand the ‘Public Health Practitioners’ grouping, select ‘Registered Nurse’ and then ‘Start’;

• Request verification of your 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 IN APPLYING:

  Check out our Applicant Tips on How to Apply! Need more resources? Visit our Applicant Reference Library (https://portal.ct.gov/das/home/services-for-state-employees/statewide-human-resources/applicant-reference-library?language=en_US) for additional support throughout the recruitment process.

  BEFORE YOU APPLY:

• Meet Minimum Qualifications: Ensure you meet the Minimum Qualifications listed on the job opening by the job closing date. You must specify your qualifications on your application. The minimum experience and training requirements listed must be met by the close date on the job opening, unless otherwise specified.

• Educational Credits: List your earned credits and degrees from accredited institutions accurately on your application. To receive educational credits towards qualification, 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 contact listed below.

• Resume Policy: Per Public Act 21-69 (https://www.cga.ct.gov/2021/act/pa/pdf/2021PA-00069-R00SB-00056-PA.pdf) , resumes are not accepted during the initial application process. As the recruitment process progresses, candidates may be required to submit additional documentation to support their qualification(s) for this position. This documentation may include: a cover letter, resume, transcripts, diplomas, performance reviews, attendance records, supervisory references, licensure, etc., at the request and discretion of the hiring agency.

• Preferred Shift/Location: Select all location(s) and shift(s) you are willing to work on your application. Failure to do so may result in not being considered for vacancies in that specific location or shift.

• Timely Submission: All application materials must be received by the job posting deadline. You will be unable to make revisions once you officially submit your application to the State. Late submissions are rarely accepted, with exceptions only for documented events that incapacitate individuals during the entire duration of the job posting. Request exceptions by emailing DAS.SHRM@ct.gov.

• Salary Calculations: 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.

• Note: The only way to apply to this posting is via the ‘Apply’ or ‘Apply Online’ buttons on the official State of Connecticut Online Employment Center job posting.

  AFTER YOU APPLY:

• Referral Questions: This posting may require completion of additional Referral Questions (RQs), which must be completed by the questionnaire’s expiration date. If requested, RQs can be accessed via an email sent to you after the job close date or by visiting your JobAps Personal Status Board (Certification Questionnaires section).

• Prepare For An Interview: Interviews are limited to those whose experience and training are most aligned with the role. To prepare, review this helpful Interview Preparation Guide to make the best impression!

• Stay connected! Log in daily to your JobAps Personal Status Board to track your status and check email (including spam/junk folders) for updates and tasks.

• The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.

• Note: This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. 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, available at www.ct.gov/ethics.

  QUESTIONS? WE’RE HERE TO HELP:

  Due to high volume, we are unable to confirm receipt or provide status updates directly. For recruitment updates, please check your Personal Status Board and review our Frequently Asked Questions. If you have additional questions about the recruitment process, reach out to INSERT TS STAFF at Christopher.Lavallee (Christopher.Lavallee@ct.gov) @ct.gov.

  Join the State of Connecticut and take your next career step with confidence!

  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.

• 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.

  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.

Click on a link below to apply for this position:

Fill out the Supplemental Questionnaire and Application NOW using the Internet. Apply Online