State of Connecticut Executive Branch

In the Department of Social Services, Home and Community Based Services unit this class is accountable for independently performing a full range of tasks associated with the provision of professional nursing consultation to access agencies who provide case management services to consumers and their families regarding social services program-based healthcare services.

Works under the general supervision of a Supervising Community Nurse Coordinator or other employee of higher grade.

• Provide consultation and case management to access agencies, health care providers, clients and family members; 
• Coordinates authorization of delivery of services with access agencies; 
• Evaluates cost and clinical appropriateness of medical, social and behavioral health aspects of care; 
• Conducts health care case reviews for quality and care management; 
• Reviews and approves or denies prior authorization requests for services; 
• Serves as a resource to clients and health insurance companies regarding rights and responsibilities;
• Serves as liaison with internal agency contacts and outside providers regarding program policies and procedures; 
• Completes health screen assessment and determines level of care eligibility; 
• Evaluates care plan to ensure compliance with cost caps and federal regulations; 
• Reviews, evaluates and authorizes requests for medical services and equipment for clients; 
• Investigates client complaints; 
• May conduct on site quality assessment and/or compliance review; 
• May represent the department in fair hearings related to medical necessity determination of nursing facility level of care; 
• May make recommendations for policy changes; 
• Performs related duties as required.

• Considerable knowledge of principles and practices of nursing care administration for variety of specialties with varied settings; 
• Knowledge of
  • relevant state and federal laws, statutes and regulations; 
  • relevant agency policy and procedures; 
  • managed care practices; 
  • principles and practices pertinent to community processes; 
  • state and federal and local health agencies and programs; 
• Considerable
  • interpersonal skills; 
  • oral and written communication skills; 
• Ability to
  • problem solve; 
  • understand and communicate health programs; 
  • utilize computer software.

Three (3) years of experience as a registered professional nurse in a position involving home healthcare, nursing homes or other community based nursing program.

Two (2) years of the General Experience must have been in the areas of client care plans or utilization review. 

NOTE: For state employees this experience is interpreted at the level of a Nurse.

In addition to the checking of references and of facts stated in the application, a thorough background investigation of each candidate may be made before persons are certified for appointment.