Utilization Review Jobs in Westerly, RI (NOW HIRING)

Introduction

Are you a Registered Nurse (RN) with experiencein hospital or institutional nursing, in a medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims?\r\n\r\nIf so, we invite you to apply and join our dedicated team!\r\n\r\n\r\n\r\n\r\n\r\nTHE POSITION\r\n\r\nThe State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is now hiring for a Utilization Review Nurseto join our team!\r\n\r\n\r\nHIGHLIGHTS\r\n\r\n\r\n FACILITY: Southeastern Mental Health Authority (SMHA)\r\n LOCATION: 401 West Thames Street, Unit 301, Norwich, CT\r\n SCHEDULE: Full-Time, 40 Hours per Week, First Shift, 8:00am - 4:30pm, Monday through Friday\r\n UNIT:Quality Management\r\n POSITION NUMBER: 84269\r\n\r\n\r\n\r\n\r\n\r\n\r\nWHAT WE CAN OFFER YOU\r\n\r\n\r\n Visit our new State Employee Benefits Overview page!\r\n Professional growth and development opportunities\r\n A healthy work/life balance to all employees\r\n \r\n \r\n \r\n \r\n \r\n DISCOVER THE OPPORTUNITY TO\r\n \r\n \r\n \r\n \r\n Be a part of a comprehensive team of caring professionals;\r\n Provide support that is passionate about improving the lives of those we serve;\r\n Assist our clients so they can achieve success;\r\n Make a difference in the public sector; and\r\n Work together in a collaborative team environment.\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n ABOUT US\r\n \r\n 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.\r\n \r\n \r\n \r\n SMHA is a community mental health agency operated by the State of Connecticut Department of Mental Health and Addiction Services (DMHAS). Its primary goal is to provide high quality behavioral health services to those in our community with mental health and substance use disorders who are 18 years or older and reside in New London County and its surrounding towns. Services, which include case management, outpatient behavioral health, crisis intervention, respite care, and forensic services, are recovery oriented and offered in a trauma informed and culturally sensitive manner. We support individuals to identify and achieve their own goals in recovery, fostering independence, dignity, and ability.\r\n \r\n \r\n \r\n \r\n \r\n PLEASE NOTE\r\n \r\n \r\n A comprehensive medical examination, including a drug screening, will be required of all applicants upon a conditional offer of employment.\r\n All state employees must adhere to Connecticut's Policy for a Drug Free Workplace.\r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n \r\n

Selection Plan

FOR THOSE WHO HOLD AN RN LICENSE IN A STATE OTHER THAN CONNECTICUT AND DO NOT HOLD A MULTISTATE OR COMPACT REGISTERED NURSING LICENSE, AND WISH TO APPLY FOR A CONNECTICUT LICENSE, PLEASE:\r\n\r\n Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;\r\n Complete a CT DPH online application online (expand the 'Public Health Practitioners' grouping, select 'Registered Nurse' and then 'Start';\r\n 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.\r\n\r\nFOR ASSISTANCE IN APPLYING:\r\nCheck out our Applicant Tips on How to Apply! Need more resources? Visit our Applicant Toolkit for additional support throughout the recruitment process.\r\nBEFORE YOU APPLY:\r\n\r\n 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. \r\n 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 by the closing date listed on the job posting.\r\n Resume Policy: Per Public Act 21-69, 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.\r\n 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.\r\n 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.\r\n 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.\r\n\r\n\r\n 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.\r\n\r\nAFTER YOU APPLY:\r\n\r\n Some email providers may experience delays or issues delivering messages. To avoid missing important updates-such as referral questionnaires or interview scheduling links-please check your Personal Status Board regularly.\r\n For added convenience, you can also enable text (SMS) notifications. To do this, log in to your Personal Status Board and select "Update My Contact Information."\r\n 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). \r\n\r\n\r\n 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!\r\n 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.\r\n The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.\r\n 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.\r\n\r\n\r\n This employer may participate in EVerify and will provide the federal government with your Form I9 information to confirm work authorization.\r\n\r\nQUESTIONS? WE'RE HERE TO HELP:\r\nDue 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 Jensine Tran at Jensine.Tran@ct.gov.\r\nJoin the State of Connecticut and take your next career step with confidence!\r\n

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

\r\n\r\n Performs a variety of duties related to review of various types of health and medical care delivery and reimbursement systems;\r\n Participates in utilization review and/or quality assurance programs;\r\n Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation;\r\n Summarizes and analyzes data;\r\n Prepares statistical reports;\r\n Implements decisions in program according to revisions in standards;\r\n Attends professional workshops, seminars and in-service training;\r\n Maintains up to date knowledge of all changes in relevant discipline;\r\n Monitors personal injuries and medical costs to evaluate need for services billed for appropriate injuries;\r\n May monitor agency and third-party administrator files to oversee contractor handling;\r\n May review medical records of various health care eligibility, resource unit referral and/or compliance with federal funding provisions;\r\n Performs related duties are required.\r\n\r\n\r\n

KNOWLEDGE, SKILL AND ABILITY

\r\n Considerable knowledge of principles, practices and current trends in nursing;\r\n Knowledge of\r\n \r\n and ability to apply relevant state and federal laws, statutes and regulations;\r\n standards of practice of medicine and nursing as well as other health care disciplines;\r\n regulations and standards pertaining to utilization review;\r\n care and service delivery to injured workers;\r\n \r\n \r\n Skills\r\n \r\n interpersonal skills;\r\n oral and written communication skills;\r\n \r\n \r\n Ability to analyze patient profile and progress charts to evaluate proper care and treatment.\r\n\r\n

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

Three (3) years of experience as a Registered Nurse.\r\n

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

\r\n\r\n Experience with Electronic Medical Records System\r\n Experience with Utilization Review and Management in a healthcare setting\r\n Experience conducting quality audits for compliance with regulations\r\n Experience with State and Federal Behavioral Health standards and regulations, including but not limited to: The Joint Commission (TJC), Centers for Medicare & Medicaid Services (CMS), Department of Public Health (DPH)\r\n Experience providing quality assurance, specifically, writing reports, creating tables and graphs, analyzing data and performance improvement protocols\r\n\r\n\r\n

SPECIAL REQUIREMENTS

\r\n\r\n Incumbents in this class must possess and retain a license as a Registered Nurse in ConnecticutOR hold a Multistate or Compact Registered Nurse license.\r\n Incumbents in this class may be required to travel.\r\n\r\n\r\n

Conclusion

AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER\r\nThe State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.\r\n

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.\r\n