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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

ConnecticutEast Hartford, CT, US
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Overview

Introduction

Are you a Registered Nurse (RN) interested in a career where you can make a difference for individuals and families? 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
  • Incumbents will be required to travel

WHAT WE CAN OFFER YOU

  • 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; qualifying student loans may be forgiven after 10 years of service.
  • Connecticut has joined the Nurse Licensure Compact effective October 1, 2025.
  • DISCOVER THE OPPORTUNITY TO Engage in a rewarding career, Make a difference in the public sector, Work together in a collaborative team environment

    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 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 licenses electronically through the National Council of State Boards of Nursing's Nursys System. To send verification of licenses to CT, follow the on-screen steps and ensure the transaction is completed. Note that PA and MI verifications are not provided through Nursys; contact those state boards for information. For assistance applying : check our Applicant Tips; visit our Applicant Reference Library for additional support. If you require an accommodation under the Americans with Disabilities Act (ADA), contact Edward Magnano, EEO Manager, at (860) 418-6148 or Edward.Magnano@ct.gov.

    BEFORE YOU APPLY :

  • Meet Minimum Qualifications : Ensure you meet the Minimum Qualifications listed on the job opening by the closing date and specify qualifications on your application.
  • Educational Credits : List earned credits and degrees accurately; if outside the U.S., provide documentation of US-recognized accreditation.
  • Resume Policy : Per Public Act 21-69, resumes are not accepted during the initial application; additional documents may be requested later.
  • Preferred Shift / Location : Select all location(s) and shift(s) you are willing to work on your application.
  • Timely Submission : All materials must be received by the deadline; revisions after submission are generally not allowed.
  • AFTER YOU APPLY :

  • Referral Questions (RQs) : Some postings require RQs completed by the expiration date.
  • Prepare For An Interview : Interviews are limited to those most aligned with the role; review the Interview Preparation Guide.
  • Stay connected : Log in to JobAps Personal Status Board for status updates.
  • The immediate vacancy is listed above; applications may be used for future vacancies in this job class. This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. Candidates offered a position must adhere to the State Code of Ethics.

    Questions? We're here to help. For recruitment updates, check your Personal Status Board and FAQ. For additional questions about the recruitment process, contact Pamela Rochette at Pamela.Rochette@ct.gov.

    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 performance evaluations; acts as liaison with other operating units, agencies and outside officials; prepares reports and correspondence; assesses, evaluates and monitors documentation of hospital disciplines during case reviews.
  • Attends professional workshops, seminars and in-service training; may supervise Utilization Review Nurses and other staff engaged in review of medical records for Medicare Part B reimbursement.
  • 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 inspection teams 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 / disease disability cases for medical management, cost containment, peer review and rehabilitation; may notify acute care hospitals of scheduled utilization review and conduct second level reviews with a physician consultant for final disposition.
  • Performs related duties as required.
  • Knowledge, Skill and Ability

    Considerable knowledge of nursing principles and practices, current trends and standards of medical care. Strong interpersonal, oral and written communication skills. Ability to analyze individual profiles and progress charts; supervisory capability. Regulatory knowledge to apply state and federal laws, regulations and standards related to utilization review and care delivery. Investigatory skills for evaluating care of individuals with intellectual disabilities; knowledge of residential facilities and applicable regulatory processes. Knowledge related to Minimum Data Set processes in long-term care and interdisciplinary team coordination; ability to utilize computer software.

    Minimum Qualifications

  • General Experience : Five (5) years of experience as a Registered Nurse.
  • Special Experience (Regulatory) : Two (2) years of the General Experience in assessment of health care quality and propriety for JCAHO / Medicare / Medicaid standards at the Utilization Review Nurse level. Investigatory : Two (2) years working with persons with behavioral health disabilities or an intellectual disability. Department of Veterans Affairs : Two (2) years in review / assessment of individuals in a long-term care setting.
  • Substitutions Allowed : A Bachelor's degree in nursing may substitute for one year of General Experience.
  • Preferred Qualifications

  • Experience with individuals with intellectual and developmental disabilities across the life span; discharge planning from hospitals or Skilled Nursing facilities to homes; OBRA nursing oversight; coordination with Private Agencies and Skilled Nursing Facilities.
  • Experience with DDS Nursing Policies, mortality review process, supervisory experience, chart auditing for quality assurance, and Microsoft Office applications.
  • Special Requirements

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

    Conclusion

    AN AFFIRMATIVE ACTION / EQUAL OPPORTUNITY EMPLOYER : The State of Connecticut is an equal opportunity / affirmative action employer; applications from women, minorities, and persons with disabilities are encouraged.

    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. A job class is not meant to be all-inclusive of every task and / or responsibility.

    J-18808-Ljbffr

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