Utilization Review Nurse Coordinator (40 Hour)
State of Connecticut - DDS West Region
Get more replies from employers
Send a job-specific resume in minutes.
Benefits offered by this job
Job summary
The State of Connecticut - DDS West Region is seeking a dedicated Registered Nurse to coordinate utilization reviews in Cheshire, CT. This role requires clinical oversight, data review, and collaboration with healthcare partners to safeguard the health and welfare of individuals receiving DDS services.
Responsibilities include managing mortality review processes, auditing clinical records, and supporting quality improvement initiatives while maintaining compliance with applicable laws and
Qualifications
- Comprehensive nursing knowledge and clinical judgment.
- Strong communication and teamwork abilities.
- Ability to analyze clinical and quality data.
Responsibilities
- Coordinate Mortality Review Committee activities and meetings.
- Review clinical and investigative documentation for concerns and trends.
- Collaborate with healthcare, regulatory, and community partners.
- Support clinical oversight, quality assurance, and compliance.
- Maintain mortality review data and case tracking systems.
- Identify opportunities for improvement and assist in corrective actions.
Skills
Education
Job description
Are you a dedicated Registered Nurse seeking a fulfilling role where you can truly impact the lives of individuals with disabilities? If so, we invite you to read more. The State of Connecticut, Department of Developmental Services (DDS) - West Region Private Health Services is recruiting for one full-time Utilization Review Nurse Coordinator (Investigatory) in Cheshire, CT. New! We’re excited that Connecticut has joined the Nurse Licensure Compact effective October 1, 2025. Incumbents in this class must possess a current license as a Registered Nurse (RN) in CT . You may verify your credentials in the Connecticut E-License Portal.
- PCN: 15975
- SHIFT: First (1st) shift | Full-time | 80 hours biweekly
- LOCATION: Cheshire, CT
- SCHEDULE: Monday through Friday 8:00 AM - 4:30 PM with Hybrid scheduling flexibility.
- PLEASE NOTE: Work schedule flexibility is required in order to meet the demands of the job.
- Professional growth and paid professional development opportunities.
- A healthy work-life balance 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.
- 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
DDS partners with the individuals we support and their families, to support lifelong planning and to join with others to create and promote meaningful opportunities for individuals to fully participate as valued members of their communities.
- 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).
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.
- 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.
- 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.
- 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
- 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.
- Five (5) years of experience as a Registered Nurse.
- 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.
- A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.
- 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 actives
- 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.
- Incumbents in this class must possess and retain a current license as a Registered Nurse in Connecticut OR hold a Multistate or Compact Registered Nurse license.
- Incumbents in this class may be required to travel.
The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.
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.
'/%3e%3cpath%20d='M101.744%2012.4726L102.894%2016.1947L99.0021%2013.2201L101.744%2012.4726ZM105.3%208.40937H100.488L99.0026%203.59473L97.5116%208.41047L92.7%208.40385L96.5965%2011.3834L95.1055%2016.1942L99.0021%2013.2196L101.408%2011.3834L105.3%208.40992V8.40937Z'%20fill='white'/%3e%3cdefs%3e%3clinearGradient%20id='paint0_linear_5593_1381'%20x1='90'%20y1='9.44471'%20x2='99'%20y2='9.44471'%20gradientUnits='userSpaceOnUse'%3e%3cstop%20stop-color='%2300AD70'/%3e%3cstop%20offset='0.998594'%20stop-color='%2300B67A'/%3e%3cstop%20offset='1'%20stop-color='%23DCDCE6'/%3e%3c/linearGradient%3e%3c/defs%3e%3c/svg%3e){kind=small}
