The State of Connecticut, Department of Social Services (DSS) is recruiting a Nurse Consultant to work in the Audit Division in our Central Office, located in Hartford, CT.

ABOUT US:

The Audit Division ensures compliance, efficiency, and accountability within federal and state programs administered by the Department by detecting and preventing mismanagement, waste and program abuse and ensuring that state and federal dollars are spent appropriately, responsibly, and in accordance with applicable laws and regulations.

KNOWLEDGE, SKILL AND ABILITY

• Considerable knowledge of
• standards of care and service delivery in community based nursing agencies, licensed home health agencies, health care facilities and institutions;
• relevant state and federal laws, statutes and regulations;
• principles and practices of nursing care administration and education for a variety of specialties with varied settings;
• principles and practices pertinent to community processes;
• Knowledge of
• state, federal and local health agencies and programs;
• nursing education and skill in techniques of teaching;
• Considerable
• interpersonal skills;
• oral and written communication skills;
• Ability to
• plan, implement and evaluate programs;
• collect and analyze data.

MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

Four (4) years of experience as a Registered Nurse in a position involving supervision, consultation, education or administration.

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

Two (2) years of the General Experience must have been in a public health nursing program, home health care agency, community health care setting, or in a hospital.

MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED

• A Bachelor’s degree in nursing may be substituted for one (1) year of the General Experience.
• A Master’s degree in health services administration, nursing or public health may be substituted for one (1) additional year of the General Experience.

PREFERRED QUALIFICATIONS

• Experience with regulation and performance compliance in the healthcare setting. Experience implementing, coordinating, and evaluating activities of assigned programs or health care services.
• Experience assessing compliance of health insurance companies with various state statutes, regulations and guidelines.

SPECIAL REQUIREMENTS

• Incumbents in this class must possess and retain a current license as a Registered Nurse in Connecticut.
• Incumbents in this class may be required to possess certification as an Insurance Rehabilitation Specialist or be eligible for certification as an Insurance Rehabilitation Specialist.
• Incumbents in this class may be required to travel.
• Incumbents in this class may be required to possess and retain a valid Motor Vehicle Operator’s license.

THE ROLE:

• Performs federally mandated audits of medical and health care providers that are paid through the various medical assistance programs administered by the Department;
• Reviews medical provider activities, audits claims, identifies overpayments, and educates providers on program integrity issues;
• Provides support and assistance to the Department Special Investigations Division in the ongoing effort to combat fraud and abuse;
• Performs data analytics to identify aberrant billing activity and pursues collection of such overpayments; and
• Substantiates whether complaints received from various sources are valid and determines the proper disposition of the complaint including conducting an audit or forwarding to the Department’s Special Investigations Division.

PURPOSE OF JOB CLASS (NATURE OF WORK)

In the Departments of Public Health, Children and Families, Correction, Developmental Services, Mental Health and Addiction Services, Social Services and the Office of Early Childhood this class is accountable for applying professional nursing knowledge in the enforcement, inspection, licensure, consultation and implementation or assessment of the nursing service component of health care programs and facilities.
In the Office of the State Treasurer, Second Injury and Assurance Fund this class is responsible for managing, directing, implementing and monitoring programs involving medical cost containment and disability management relating to occupational injuries and loss control matters.

EXAMPLES OF DUTIES

• Implements, coordinates, and evaluates activities of assigned programs or health care services;
• Maintains active liaison with and serves as nursing consultant to other sections, divisions, health care providers and public;
• Assesses safety and quality of client care provided;
• Assesses compliance of health insurance companies with various state statutes, regulations and guidelines;
• Provides consultation and reviews, evaluates and authorizes requests for medical placement services or equipment for clients covered under medical assistance programs;
• Evaluates requests from health care providers asking to be included in medical assistance programs and offers consultation regarding interpretation of programs, policies and regulations;
• May inspect and evaluate health care and psychiatric facilities for compliance with state and federal regulations including licensure and certification laws;
• Performs related duties as required.