Utilization Review Nurse Coordinator (40 Hour)

DDS West Region•Cheshire, CT

8d•Onsite

About The Position

The State of Connecticut, Department of Developmental Services (DDS) - West Region Private Health Services is recruiting for one full-time Utilization Review Nurse Coordinator in Cheshire, CT. This role is for a dedicated Registered Nurse seeking a fulfilling role where they can impact the lives of individuals with disabilities. The position involves coordinating Regional Mortality Review Committee activities, reviewing and evaluating clinical documentation, collaborating with various partners, supporting clinical oversight and quality assurance, conducting clinical record audits, maintaining data systems, analyzing clinical data for trends and improvements, assisting in corrective actions, supporting DDS compliance with healthcare requirements, and providing clinical and administrative support to the Regional Health Services Director (RHSD).

Requirements

Current license as a Registered Nurse (RN) in CT OR hold a Multistate or Compact Registered Nurse license.
Five (5) years of experience as a Registered Nurse.
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.
Two (2) years of the General Experience must have been working with persons with behavioral health disabilities or an intellectual disability.
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
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.
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.

Nice To Haves

Experience participating in mortality review processes, including clinical case review and quality assurance activities
Experience with data management, case tracking, and maintaining systems used to monitor clinical and quality assurance activities
Experience conducting quality assurance reviews of medical records and healthcare documentation
Knowledge and experience with CMS, OBRA, DPH, and other healthcare regulatory requirements
Experience collaborating with healthcare, regulatory, investigative, and community partners, and multidisciplinary teams.
Knowledge and experience of healthcare services for individuals with intellectual and developmental disabilities.

Responsibilities

Coordinate Regional Mortality Review Committee activities; including scheduling meetings, obtaining and organizing pertinent healthcare information and medical records, and assisting with preparation of case materials for committee review.
Review and evaluate clinical, medical, and investigative documentation to identify concerns, trends, and areas requiring follow-up.
Collaborate with healthcare, regulatory, investigative, and community partners to obtain and evaluate clinical information necessary to support mortality review, quality assurance, and other departmental oversight activities.
Support clinical oversight, accountability, and quality assurance activities necessary to safeguard the health, safety, and welfare of individuals receiving DDS services.
Conduct clinical record audits and quality assurance reviews to evaluate adherence to applicable laws, regulations, policies, procedures, and professional standards.
Maintain mortality review data, case tracking systems, and related records to support timely case review, follow-up, reporting, and quality improvement activities.
Analyze clinical and quality data to identify trends, systemic concerns, and opportunities for improvements, with the goal of strengthening systems of care and reducing preventable adverse outcomes.
Assist in the development and implementation of corrective actions and quality improvement initiatives.
Support DDS compliance with applicable federal and state healthcare requirements.
Provide clinical and administrative support to the RHSD in carrying out mortality review and related oversight activities.
Participate in and provide clinical support to regional committees, review processes, and other clinical oversight activities as directed by the RHSD (Regional Health Services Director).