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

Description

• 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.
• May review medical records of various health care eligibility, resource unit referral and/or compliance with federal funding provisions;
• Summarizes and analyzes data;
• care and service delivery to injured workers;
• Participate in treatment team meetings and provide feedback on level of care, discharge planning, and related matters
• 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;
• Conduct ongoing audits and tracers of inpatient documentation to support compliance with Joint Commission and CMS Medicare/Medicaid standards and regulations
• Implements decisions in program according to revisions in standards;
• Prepares statistical reports;
• Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation;
• Complete a CT DPH online application online (expand the ‘Public Health Practitioners’ grouping, select ‘Registered Nurse’ and then ‘Start’;
• Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;
• Attends professional workshops, seminars and in-service training;
• Monitor length of stay and coordinate with treatment teams on discharge planning
• Communicate with patients regarding their entitlements (Medicare/Medicaid, private insurance) and ensure all relevant paperwork is signed
• Participates in utilization review and/or quality assurance programs;
• Performs a variety of duties related to review of various types of health and medical care delivery and reimbursement systems;
• Collaborate with the Department of Administrative Services (DAS) billing team to ensure accurate reimbursement for inpatient stays

Requirements

• and ability to apply relevant state and federal laws, statutes and regulations;
• Ability to analyze patient profile and progress charts to evaluate proper care and treatment.
• standards of practice of medicine and nursing as well as other health care disciplines;
• Incumbents in this class must possess and retain a license as a Registered Nurse in Connecticut OR hold a Multistate or Compact Registered Nurse license.
• A comprehensive medical examination, including a drug screening, will be required of all applicants upon a conditional offer of employment.
• Experience with inpatient psychiatric hospitalization and discharge focused treatment planning
• 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).
• Experience participating within a multidisciplinary treatment team
• Maintains up to date knowledge of all changes in relevant discipline;
• Knowledge of
• Experience with Medicare Part B billing requirements
• Incumbents in this class may be required to travel.
• Considerable knowledge of principles, practices and current trends in nursing;
• interpersonal skills;
• Experience with Microsoft Excel, Microsoft Word and other programs to collect, analyze and report data
• oral and written communication skills;
• All state employees must adhere to Connecticut’s Policy for a Drug Free Workplace.
• Experience teaching and providing guidance to providers on how to improve the level of quality in their documentation
• Experience with Medicare/Medicaid and commercial insurances (authorizations, billable services, level of care criteria)

Benefits

• A health work/life balance
• Professional growth and development opportunities

Training + Development

Interview process

Visa Sponsorship

Security clearance