Utilization Review Nurse Office​/On-site

Are you a Registered Nurse (RN) with experience in hospital or institutional nursing, in a medical treatment facility, in rehabilitative or occupational nursing or providing medical review of insurance claims?

The State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is now hiring for a Utilization Review Nurse to join our team!

• FACILITY:
  Capitol Region Mental Health Center (CRMHC)
• LOCATION:
  
  Hartford, CT
• UNIT:
  Inpatient
• SCHEDULE:
  
  Full-Time (40 hours/week), Monday
  - Friday, 8:00 AM - 4:30 PM (First Shift)
• POSITION NUMBER: 26806

Visit our new State Employee Benefits Overview page!

• Professional growth and development opportunities
• A healthy work/life balance to all employees

NEW! We're excited that Connecticut has joined the Nurse Licensure Compact effective October 1, 2025. Visit the Nurse Licensure Compact for more details.

• Assess, evaluate, and audit medical records to ensure quality of care and confirm clients meet the appropriate level of care
• Apply knowledge of federal and/or state statutes, regulations, and guidelines in daily work
• Assist with authorization of services for Medicare, Medicaid, and private insurance companies
• Perform insurance verification using tools such as Inovalon, CTDSS, AP, and NGS Connex
• Update insurance information using the WITS system
• Summarize and analyze audit findings and report needed corrections to the appropriate disciplines
• Participate in treatment team meetings to ensure each client’s plan of care reflects their identified needs
• Apply knowledge related to billing and coding for services provided
• Monitor and update the Utilization Management Plan and chair the Utilization Management Committee

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.

CRMHC is a community-based mental health center serving Hartford, West Hartford, Farmington, Avon, Canton, and Simsbury. CRMHC partners closely with DMHAS-funded programs across the Greater Hartford region, working with 15 nonprofit agencies to provide a comprehensive network of behavioral health services for adults with serious psychiatric conditions and co-occurring substance use disorders.

A comprehensive medical examination, including a drug screening, will be required of all applicants upon a conditional offer of employment.

All state employees must adhere to Connecticut's Policy for a Drug Free Workplace.

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.

• Performs a variety of duties related to review of various types of health and medical care delivery and reimbursement systems;
• Participates in utilization review and/or quality assurance programs;
• Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation;
• Summarizes and analyzes data;
• Prepares statistical reports;
• Implements decisions in program according to revisions in standards;
• Attends professional workshops, seminars and in-service training;
• Maintains up to date knowledge of all changes in relevant discipline;
• 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;
• May review medical records of various health care eligibility, resource unit referral and/or compliance with federal funding provisions;
• Performs related duties are required.

• Considerable knowledge of principles, practices and current trends in nursing;
• Knowledge of and ability to apply relevant state and federal laws, statutes and regulations;
• standards of practice of medicine and nursing as well as other health care disciplines;
• regulations and standards pertaining to utilization review;
• care and service delivery to injured workers;
• Skills interpersonal skills;
• oral and written…