Utilization Review Nurse — Inpatient Mental Health (Day Shift)

State of Connecticut; Hartford (CT); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Professional growth opportunities

Healthy work-life balance

Job summary

The State of Connecticut's Department of Mental Health and Addiction Services (DMHAS) seeks a Utilization Review Nurse in Hartford to join the Capitol Region Mental Health Center. This inpatient unit role is full-time, with standard daytime hours, and focuses on review of care, insurance verification, and cost containment.

Ideal candidates hold an RN license, with 3 years of nursing experience and 1 year in relevant settings; a BSN may substitute.

Qualifications

• Three (3) years as a Registered Nurse.
• One (1) year in hospital or institutional nursing or medical review.
• Bachelor's degree may substitute for one year of experience.
• Experience with reimbursement of healthcare services is preferred.
• Knowledge of insurance verification tools is preferred.
• Familiarity with State/Federal utilization review standards.

Responsibilities

• Assess, audit, and evaluate medical records for quality and level of care.
• Apply federal/state statutes and regulations in daily work.
• Assist with authorization of services for Medicare/Medicaid and private insurers.
• Perform insurance verification using listed tools.
• Update insurance information in the WITS system.
• Summarize audit findings and report corrections to relevant teams.
• Participate in treatment team meetings to align plans of care.
• Maintain knowledge of billing and coding for services provided.
• Monitor the Utilization Management Plan and chair committee meetings.

Skills

Nursing knowledge

Regulatory knowledge

Interpersonal skills

Oral and written communication

Analytical skills

Education

RN license (CT or Multistate/Compact)

Tools

Inovalon

CTDSS

AP

NGS Connex

WITS system

Job description

The State of Connecticut's Department of Mental Health and Addiction Services (DMHAS) seeks a Utilization Review Nurse in Hartford to join the Capitol Region Mental Health Center. This inpatient unit role is full-time, with standard daytime hours, and focuses on review of care, insurance verification, and cost containment.

Ideal candidates hold an RN license, with 3 years of nursing experience and 1 year in relevant settings; a BSN may substitute.