field_remote_option

field_job_employment_type

job_industry

field_job_occupational_field_parents_all

field_job_experience

job_organization_name

<p>Salary Range:&nbsp;&nbsp;$88,854.00&nbsp;(Min.) -&nbsp;$115,509.00&nbsp;(Mid.) -&nbsp;$142,166.00&nbsp;(Max.)</p><p>PLEASE NOTE:&nbsp; This position will work&nbsp;Wednesday - Sunday, 7 a.m. to 4 p.m. PST, with rotating holidays.</p><p>Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.<br><br>Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.<br></p><h4>Job Summary</h4><p><br>The Customer Solution Center Appeals and Grievances (A&amp;G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines. Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS )Medi-Cal/Medicare, or commercial insurance.&nbsp;</p><h4>Duties</h4><p>Conducts intake/triage and appropriate classification of Clinical A&amp;G, and Pharmacy requests and makes accurate judgment on appeal, grievance, Provider Claim Disputes, medical records or other issues and follows procedures on how to handle each type of request and route to the appropriate area within the department.</p><p>Investigation, and resolution of clinical member complaints (grievances/appeals) utilizing all regulatory requirements.&nbsp; Investigation, and resolution of clinical Provider Complaints/ Provider Data Resolution (PDR) (grievances/appeals) utilizing regulatory and internal guidelines and Service Level Agreement (SLA). Identification of Expedited Cases and resolution within 72 hours.</p><p>Works with the external providers and Participating Physician Group's (PPG) representatives to obtain relevant medical records and communication documentation.</p><p>Prepares resolved complaint files for Centers for Medicare and Medicaid Services (CMS), DMHC, and external review organization (QIO or IRE).&nbsp; Process the case thru to effectuation and final case documentation in the A&amp;G system of record.</p><p>Investigation and preparation of State Fair Hearing cases as assigned. Prepares resolved complaint files for CMS external review organization - Quality Improvement Organization (QIO) or Independent Review Entity (IRE).</p><p>Conducts reviews and presents to physicians, provider disputes which would be based on medical necessity reviews. Prepares authorizations, after approval by the Medical Director.</p><p>When necessary, outreaches to providers, vendors, hospitals, and members to request necessary information or to provide case status and/or next steps.&nbsp; In instances where necessary, sends written notifications to appropriate parties. All interactions including verbal outreach and written communication will be documented in the A&amp;G system of record. </p><p>Participates inter-rater reliability training and assessments.</p><h4>Perform other duties as assigned.</h4><h4>Duties Continued</h4><h4>Education Required</h4>Associate's Degree in Nursing<h4>Education Preferred</h4>Bachelor's Degree in Nursing<h4>Experience</h4><p>Required:</p><p>At least 5 years of experience in Clinical Nursing and 2 years in Medicare/ Medicaid in a managed care/ health plan environment. </p><h4>Skills</h4><p><br>Required:</p><p>Excellent interpersonal and communication skills. </p><p>Computer literacy and adaptability to computer learning. </p><p>Time management and priority setting skills.</p><p>Must be organized and a team player </p><p>Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies.</p><p>Good working knowledge of regulatory requirements/standards.</p><h4>Licenses/Certifications Required</h4>Registered Nurse (RN) - Active, current and unrestricted California License<h4>Licenses/Certifications Preferred</h4><h4>Required Training</h4><h4>Physical Requirements</h4>Light<h4>Additional Information</h4><p>This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call.</p><p>This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned</p><p>Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.&nbsp; The range is subject to change.</p><p>L.A. Care offers&nbsp;a wide range of benefits including</p><ul><li>Paid Time Off (PTO)</li><li>Tuition Reimbursement</li><li>Retirement Plans</li><li>Medical, Dental and Vision</li><li>Wellness Program</li><li>Volunteer Time Off (VTO)</li></ul><p><br><strong>Nearest Major Market: </strong>Los Angeles                                                                            <br><strong>Job Segment: </strong>                    Nursing, Registered Nurse, Medicare, Medicaid, Pharmacy, Healthcare                                                    </p>

L.A. Care Health Plan

Customer Solution Center Appeals and Grievances Nurse Specialist RN II

<p><strong>October 1st START DATE</strong></p><p><strong>Case Manager at National Life Group</strong></p><p><strong>The Opportunity to Make a Difference</strong></p><p>Our Case Managers deliver a superior customer experience to the distribution channels—agent or agencies—by ensuring life insurance applications are processed with the speed, accuracy and caring curiosity that gives our customer peace of mind.&nbsp; In addition to&nbsp;assessing basic life insurance risk, you will empower our customers by providing information, help to resolve application issues, and collaborate with the team to reach our full potential and achieve results.</p><p>A typical day finds the Case Manager assessing medical, nonmedical and financial risk factors and determining appropriate rating for life applications, processing applications in workflow management systems, collaborating within a team, and effectively communicating with the agent/agency via phone, email, and CRM.&nbsp;&nbsp; You will be the primary liaison with the producing agent(s)/agency throughout the&nbsp;life cycle of each application.</p><p>We encourage and provide professional and personal development opportunities in between handling your daily work with various courses and seminars through our very own NL University.&nbsp; In addition, you will be part of a small, but mighty, work-family working toward our annual goals and developing yourself and teammates along the way…and all for a common Cause!</p><p><strong>Successful Candidates We’re Seeking</strong></p><ul><li>You have 2+ years of professional work experience interacting with customers in life insurance and/or annuity field(s)</li><li>You are passionate about working for a company with a cause-driven culture</li><li>A college degree is not required, but it is preferred; ultimately, we value high quality skills, experience and a winning attitude as much as an earned degree</li><li>Must be able to successfully pass a background check that may include fingerprinting</li></ul><p><strong>The Skills to Succeed</strong></p><ul><li>You are detail-oriented and great at multi-tasking in a fast-paced environment</li><li>You are an excellent communicator, with empathy and strong listening skills</li><li>You are results-oriented, are great with people and not afraid to lead</li><li>You are an intuitive problem-solver who thinks critically and creatively to deliver the right solution</li><li>You enjoy delighting customers with exceptional service</li><li>You exercise sound judgement&nbsp;and independent thinking in decision making, make while balancing the need for collaboration in a team</li><li>You have a knack for seeing how things can be done more efficiently and effectively, and are open to continuous&nbsp;improvement and change</li><li>You demonstrate a healthy curiosity and passion to continually learn and improve business acumen</li><li>You are adaptable and can roll with change that occurs within a rapidly growing company</li></ul><p><strong>What You’ll Find at National Life Group</strong></p><ul><li>Competitive pay and outstanding health, wellness and insurance benefits</li><li>Genuine opportunities for growth and career advancement</li><li>Fun collaborative, team-based environment</li><li>Paid training and development through NL University</li><li>Over $5k in annual tuition reimbursement, including&nbsp;full tuition sponsorship&nbsp;for completing your undergraduate and graduate degrees with&nbsp;University of Arizona World Campus</li><li>Paid time off and holidays</li><li>40 hours of paid community service hours annually</li><li>Onsite fitness center</li><li>A culture committed to inclusion and diversity</li></ul><p>We’ve been keeping our promise to our people, customers, community and environment since 1848.&nbsp; Come join our cause!</p><h6>The base compensation range represents the low and high end of the range for this position. Actual compensation will vary and may be above or below the range based on various factors including but not limited to qualifications, skills, competencies, location, and experience. The range listed is just one component of our total compensation package for employees.</h6><h6>Other rewards may include an annual bonus, quarterly bonuses, commissions, and other long-term incentive compensation, depending on the position.&nbsp; National Life offers a competitive total rewards package which includes: a 401(k) retirement plan match; medical, dental, and vision insurance; a company funded wellness account for director and below employees; 10 paid holidays; a generous paid time off plan (22 days of combined time-off for non-exempt employees and exempt employees have discretion in managing their time, including scheduling time off in the normal course of business, but in no event will exempt employees receive less sick time than required by state or local law); 6 weeks of paid parental leave; and 6 weeks of paid family leave after a year of full-time employment</h6><h6>National Life Group® is a trade name of National Life Insurance Company, Montpelier, VT – founded in 1848, Life Insurance Company of the Southwest, Addison, TX – chartered in 1955, and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. Life Insurance Company of the Southwest is not an authorized insurer in New York and does not conduct insurance business in New York. Equity Services, Inc., Member FINRA/SIPC, is a Broker/Dealer and Registered Investment Adviser affiliate of National Life Insurance Company. All other entities are independent of the companies of National Life Group.</h6><h6>Fortune 1000 status is based on the consolidated financial results of all National Life Group companies.&nbsp;</h6><h6>National Life Group</h6><h6>1 National Life Dr</h6><h6>Montpelier, VT 05604</h6><h6>Social Media Policy&nbsp;</h6><h6>Site Disclosure and Privacy Policy&nbsp;</h6>

National Life Group

Life New Business Case Manager

<p><strong>Essential Duties and Responsibilities</strong> include the following. Other duties and tasks may be assigned.</p><ul><li>Demonstrate effective use of supplies and staff labor hours.</li><li> May assist with billing log preparation and updates.</li><li>Perform duties as assigned to meet the patient care or operational needs of the clinic</li><li> Obtain blood samples for laboratory analysis as required to complete physician orders.</li><li> Complete and document monthly review of patient medication profiles.</li><li>Knowledge of and comply with applicable health care professionals practice act requirements.</li><li>Perform duties at all times under the supervision of a Charge Nurse and within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations</li><li>Maintain thorough, accurate, and appropriate documentation in the patient record of all treatments, activities, and communication with the patient, physician and other healthcare professionals to include progress reports.</li><li>Report any significant information or change in patient condition to the Charge Nurse.</li><li> Report machine problems to Biomedical Technician and Administrator.</li><li> Participate in staff meetings as required. Attend in-service and continuing education offerings in compliance with company policy and procedure.</li><li>Assist with staff training as requested.</li></ul>

U.S. Renal Care

Dialysis Licensed Vocational Nurse - LVN Chronic In-center

<p>The <strong>RN Charge Nurse</strong> is responsible for overseeing nursing services each shift and functions as a nursing supervisor. This position provides daily supervision of staff on duty during operational hours.</p><p>Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.</p><ul><li> Assist with clinical and operational processes to improve patient health and minimize hospitalizations and missed treatments.</li><li> Demonstrate effective use of supplies and staff labor hours.</li><li> Complete and document monthly review of patient medication profiles. Administer medications as ordered by the physician.</li><li> Assist physician during patient rounds and transcribe and implement physician orders timely.</li><li> Assist with the implementation of anemia management and medication protocols as requested.</li><li> Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements.</li><li> Perform duties at all times within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations.</li><li> May give direct patient care to the extent of performing efficient, safe dialysis, if allowed by state regulations.</li><li> Responds to all emergencies in clinic.</li><li> Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient.</li><li> Maintain collaborative working relationship with Medical Director and physicians.</li><li> Participate as a member of the Interdisciplinary team in all required patient assessment and care planning activities.</li><li> Assist in orientation of new staff as a preceptor or in assigning a preceptor.</li><li> Acts as resource person and participates in implementing and evaluating dialysis services and assures that policies and procedures are updated.</li><li>Assists Administrator in interviewing, hiring, evaluating, and disciplinary actions of center staff</li></ul>

Dialysis Charge Nurse Part-Time - RN Chronic In-center (MWF 4 pm-Midnight)

<h4><em><strong>How you'll change lives</strong></em></h4><p>As a Registered Nurse (RN) at US Renal Care, you'll be an integral part of a cross-functional team, working under the supervision of a Charge Nurse and assisting and supervising Patient Care Technicians (PCTs) to care for patients living with kidney disease.</p><h4><em><strong>What you'll be doing</strong></em></h4><p><strong>Patient care.</strong> You'll work directly with patients to provide safe, comfortable, and high-quality dialysis treatment. Responsibilities include completing and documenting physical assessments before and after treatments and monitoring patients during treatment. You'll ensure quality renal care by completing monthly reviews of patient medication profiles and administering medications according to physician orders. </p><p><strong>Teamwork.</strong> You'll be a critical member of an interdisciplinary team to provide all required patient assessment and care planning activities. You'll also make sure center staffing requirements are met at all times under the direction of the Administrator and according to state regulations for staffing ratios.</p><p><strong>Safety &amp; Quality.</strong> Working under the supervision of a Charge Nurse, you'll adhere to all company policies and procedures and state and federal laws and regulations. You'll participate in all required staff meetings and continuing education offerings.</p>

Dialysis Registered Nurse

Dialysis Registered Charge Nurse

Dialysis Registered Nurse - Hilo Acutes

<br><h4>Introduction</h4><br><em>Experienced RNs - we are hiring! Check out this great opportunity with the State of Connecticut below.</em><br><br>The Connecticut Department of Correction is seeking highly motivated, experienced and licensed <strong>Supervising Nurse (Correctional Facility)</strong> to join our Health Services Unit at the MacDougall-Walker Correctional Institution, located in Suffield.<br><br><strong>WHAT WE CAN OFFER YOU<br></strong><ul><li>Visit our new&nbsp;State Employee Benefits Overview&nbsp;page!&nbsp;</li><li>A Hazardous Duty pension plan (State Employees Retirement System Tier IV)- Retire in 25 years - with pension &amp; healthcare benefits</li><li>Generous paid time off (vacation, sick and personal);</li><li>Comprehensive Benefit Offerings along with additional supplemental benefits</li><li>Career mobility - get paid to go to school (5 year work requirement)</li><li>Tuition Reimbursement after 6 months;</li><li>Nursing licensure reimbursement;</li><li>Conference and workshop funds allotment $1,500.00 (travel, food, lodging).</li></ul><br><strong>POSITION DETAILS</strong><br><br>This is a full-time, 40 hours per week position on 2nd shift. Schedule is Monday-Friday between 1:00pm and 9:00pm.&nbsp;<br><br>Correctional nursing is the delivery of evidence-based nursing to protect, promote, and optimize health and abilities; prevent illness and injury; facilitate healing; alleviate suffering through the diagnosis and treatment of human response with care and respect; and advocate for individuals, families, groups, communities, and populations under the jurisdiction of the justice system.<br><br>The MacDougall-Walker Correctional Institution is a level 4/5, high/maximum security level multi-mission facility for adult males. Based on its offender population, it is the largest correctional facility in New England. It came into being on May 15, 2001 as the result of the consolidation of the Walker Reception and Special Management Unit and the MacDougall Correctional Institution and sits on a combined 140 acres.<br><br><strong>HEAR FROM OUR EMPLOYEES</strong><br><br><strong>Mara Scott</strong>, a Supervising Nurse for the Connecticut Department of Correction, discusses her advancement from a Nurse to a Head Nurse Supervisor in the DOC, the abundance of opportunities Corrections has to offer, and the family-like atmosphere among DOC staff.<br><br><em>Our Mission:&nbsp;The Department of Correction shall strive to be a global leader in progressive correctional practices and partnered re-entry initiatives to support responsive evidence-based practices aligned to law-abiding and accountable behaviors. Safety and security shall be a priority component of this responsibility as it pertains to staff, victims, citizens and offenders.</em><br><h4>Selection Plan</h4><br><strong>Before you apply:</strong><br><br><ul><li>In order to be considered for this job opening, you must meet the Minimum Qualifications as listed on the job opening. You must specify your qualifications on your application.</li><li>The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.</li><li>Ensure that your application is complete and detailed before submitting it. In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process. You will not be able to make revisions once your application is submitted into the JobAps system.</li><li>All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period. It is the candidate’s obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception. Requests should be made to&nbsp;<a href="mailto:DAS.SHRM@ct.gov" target="_blank">DAS.SHRM@ct.gov</a>.</li><li>For current state employees, salary calculations are not necessarily comparable from branch to branch but it does not impact your state service credit.<br></li></ul><strong>Important information for after you apply:</strong><br><ul><li>This posting may require completion of additional referral questions (RQs). You can access these RQs via an email that will be sent to you after the posting's closing date or by visiting your JobAps Personal Status Board (Certification Questionnaires section). Your responses to these RQs must be submitted by the questionnaire's expiration date. Please regularly check your email and JobAps Personal Status Board for notifications. Please check your SPAM and/or Junk folders on a daily basis in the event an email provider places auto-notification emails in a user's spam.</li><li>Although applicants will receive correspondence via email, as a backup they are also encouraged to sign on to their Personal Status Board on a daily basis to monitor their status, view all emailed notices and complete tasks required in the recruitment process.</li><li>Note: At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position. These documents may include: a cover letter, resume, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency.</li><li>For current state employees, salary calculations are not necessarily comparable from one of the three branches of state government (i.e., Executive, Legislative, Judicial) to the other.<br></li><li>The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.</li></ul>Questions about this position should be directed to Jake Ferrari at&nbsp;<a href="mailto:jake.ferrari@ct.gov" target="_blank">jake.ferrari@ct.gov</a>.<br><h4>PURPOSE OF JOB CLASS (NATURE OF WORK)</h4><br>    In the Department of Correction this class is accountable for supervising nursing staff engaged in professional nursing activities.   <br><h4>EXAMPLES OF DUTIES</h4><br><ul><li>Schedules, assigns, oversees and reviews the work of staff;&nbsp;</li><li>Ensures that goals, objectives and work performed are consistent with standards and that quality care is provided to inmates;&nbsp;</li><li>Provides clinical guidance to nursing staff;&nbsp;</li><li>Selects, develops, motivates and evaluates staff;&nbsp;</li><li>Conducts performance evaluations;&nbsp;</li><li>Monitors the quality of documentation, records and other information concerning services and care;&nbsp;</li><li>Ensures that resources are available to provide quality services;&nbsp;</li><li>Participates in the development of policies and procedures to ensure efficient and effective delivery of services;&nbsp;</li><li>Participates in the development of long-range plans for health care programs;&nbsp;</li><li>Acts as a liaison with other units, agencies and outside organizations;&nbsp;</li><li>Prepares reports and correspondence;&nbsp;</li><li>Responds to psychiatric or medical emergencies;&nbsp;</li><li>May provide inmate care;&nbsp;</li><li>May physically restrain inmates, quell disturbances and otherwise assist custodial forces in emergencies;&nbsp;</li><li>Performs related duties as required.</li></ul><br><h4>KNOWLEDGE, SKILL AND ABILITY</h4><br><ul><li>Considerable knowledge of    <ul><li>and ability to apply nursing principles, clinical therapeutic models, and standards of nursing;&nbsp;</li><li>specialized inmate care;&nbsp;</li><li>current medications, their actions, interactions, uses and side effects;&nbsp;</li><li>and sensitivity to cultural and socio-economic differences;&nbsp;</li></ul></li><li>Knowledge of management and administrative principles and human resource development strategies;&nbsp;</li><li>Considerable    <ul><li>interpersonal skills;&nbsp;</li><li>oral and written communication skills;&nbsp;</li></ul></li><li>Considerable ability to    <ul><li>establish and maintain collaborative relationships with other professionals;&nbsp;</li><li>encourage and facilitate cooperation, pride, trust and group identity to foster commitment and teamwork;&nbsp;</li><li>provide leadership and guidance in developing and maintaining nursing standards and enhancing health care systems for the delivery of essential services;&nbsp;</li><li>respond to crises and emergencies;&nbsp;</li><li>use professional judgment to identify areas for improvement and participate in development of quality initiatives;&nbsp;</li></ul></li><li>Supervisory ability.</li></ul><br><h4>MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE</h4><br>    Four (4) years of experience as a Registered Professional Nurse.   <br><h4>MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE</h4><br>    Two (2) years of General Experience must have been at the level of a Head Nurse, Head Nurse (Correctional Facility), Forensic Head Nurse or Clinical Nurse Coordinator.   <br><h4>MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED</h4><br><ul><li>A Bachelor’s degree in nursing may be substituted for one (1) year of the General Experience.</li><li>A Master's degree in nursing may be substituted for one (1) additional year of the General Experience.</li></ul><br><h4>PREFERRED QUALIFICATIONS</h4><br><ul><li>Supervisory experience;</li><li>Emergency/Medical Surgery experience;</li><li>Experience working in a correctional facility.</li></ul><br><h4>SPECIAL REQUIREMENTS</h4><br><ul><li>Incumbents in this class must possess and retain a current license or temporary permit as a Registered Professional Nurse in Connecticut.</li><li>Candidates may be required to have experience working with adolescents or in women's health or mental health care.</li><li>Incumbents in this class may be required to be fluent in a foreign language or proficient in the use of the American Sign Language in certain designated positions.</li><li>Incumbents in this class may be required to possess and retain a valid Motor Vehicle Operator’s license.</li><li>Incumbents in this class may be required to travel.</li></ul><br><h4>CHARACTER REQUIREMENTS</h4><br>    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 permanent appointment.   <br><h4>PHYSICAL REQUIREMENTS</h4><br>    Candidates must be in good general health; candidates must have and retain sufficient stamina, agility, and visual and auditory acuity necessary to perform all duties of the class.  Applicants are required to pass a physical examination.   <br><h4>WORKING CONDITIONS</h4><br>    Incumbents in this class may be required to lift and restrain inmates; may have some exposure to communicable/infectious diseases and to risk of injury from assaultive/abusive inmates; may be exposed to disagreeable conditions.   <br><h4>Conclusion</h4><br><strong>AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER</strong><br><br>The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.<br><h4>ACKNOWLEDGEMENT</h4><br>    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.&nbsp; As such, a job class is not meant to be all-inclusive of every task and/or responsibility.   <br>

State of Connecticut

Supervising Nurse (Correctional Facility) (40 Hour)

<br><h4>Introduction</h4><br>    Are you a passionate healthcare professional looking to make a tangible impact on Medicaid and Children's Health Insurance Programs (HUSKY Health)? We will empower you to lead groundbreaking healthcare initiatives that drive program quality, enhance community health, and promote social justice. We believe in fostering strong partnerships and open communication, and we are committed to shaping policies that ensure equity and inclusivity. Are you ready to join us in leveraging your clinical expertise and data-driven decision-making skills to shape the future of healthcare in Connecticut?<br><br><strong>Unique Opportunity</strong><br>We have an outstanding opportunity for a Nurse Consultant to join our Department of Social Services (DSS). In the Division of Health Services, Integrated Care Unit-Medical Administration, you will coordinate administrative service contracting for HUSKY Health Medicaid and CHIP, making a direct impact on community health and well-being. As a Nurse Consultant, you will be tasked with:<br><ul><li>Leading program quality, ensuring contract compliance for the medical ASO contract.</li><li> Monitoring clinical contractual obligations, ensuring compliance with state and federal laws, regulations, and quality assurance activities.</li><li>Serving as a liaison between department sections, healthcare providers, and the public to enhance communication and collaboration.</li><li>Developing healthcare program goals, evaluating health service outcomes, and applying statistical data for data-driven decision-making.</li><li>Leading value-based purchasing initiatives, addressing social justice issues in data science, and presenting program initiatives at internal and public meetings.</li></ul><br><br><strong>Benefits</strong><br><br>The State of Connecticut prioritizes the well-being of our employees and recognize the importance of maintaining a harmonious work-life balance. Alongside competitive compensation, we provide a range of benefits, including medical, dental, and vision insurance, retirement plans, paid time off, and professional development opportunities.<br><br><ul><li><strong>Visit our&nbsp;</strong>new&nbsp;State Employee Benefits Overview&nbsp;page!</li><li>Work for a Forbes top company: 'Forbes'&nbsp;State of Connecticut Ranked One of the Best Employers of 2023&nbsp;- State of CT Receives National Recognition for Offering Job Growth, Competitive Benefits, and Flexible Schedule.</li></ul><br><br>To excel in this role, you'll bring a deep understanding of Connecticut’s Medicaid and Children’s Health Insurance Program (HUSKY Health), with the ability to interpret federal and state policies to ensure effective implementation. You will collaborate closely with internal teams and external stakeholders to build strong partnerships, fostering open communication and shared goals. Your expertise in applying data-driven insights and healthcare standards will support strategic decision-making and continuous improvement. A commitment to addressing social justice in healthcare will be central to shaping policies that promote equity and inclusivity. Working together, we'll ensure that every project is managed smoothly, meeting tight deadlines while maintaining a focus on quality and impact.    <br><h4>Selection Plan</h4><br><ul><li>Please visit our 'Applicant Tips on How to Apply' page or view our&nbsp;tutorial.</li><li>The minimum experience and training requirements must be met by the close&nbsp;date on the job opening, unless otherwise specified.</li><li>Although applicants will receive correspondence via email, as a backup they are also encouraged to sign on to their Personal Status Board on a daily basis to monitor their status, view all emailed notices and complete tasks required in the recruitment process.&nbsp;            </li><li>In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process.&nbsp;&nbsp;</li><li>This posting may require completion of additional referral questions (RQs). You can access these RQs via an email that will be sent to you after the posting's closing date or by visiting your&nbsp;JobAps&nbsp;Personal Status Board (Certification Questionnaires section). Your responses to these RQs must be submitted by the question's expiration date. Please regularly check your email and&nbsp;JobAps&nbsp;Personal Status Board for notifications. Please check your SPAM and/or Junk folders on a daily basis in the event an email provider places auto-notification emails in a user's spam.&nbsp;</li><li>Note:&nbsp; At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position.&nbsp; These documents may include:&nbsp; a cover letter, resume, transcripts, diplomas, performance reviews, attendance records, supervisory references, licensure, etc., at the discretion of the hiring agency.&nbsp; Applicants must meet the minimum qualifications as indicated to apply for this position.&nbsp;</li><li>Should you have questions pertaining to this recruitment, please contact Liz&nbsp;Pinette&nbsp;at&nbsp;<a href="mailto:elizabeth.pinette@ct.gov" target="_blank">elizabeth.pinette@ct.gov</a>.</li><li>This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules.</li><li>The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.</li><li>All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period.&nbsp; It is the candidate’s obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception.&nbsp; Requests should be made to&nbsp;<a href="mailto:DAS.SHRM@ct.gov" target="_blank">DAS.SHRM@ct.gov</a>.</li><li>For current state employees, salary calculations are not necessarily comparable from one of the three branches of state government (i.e., Executive, Legislative, Judicial) to the other.</li><li>Read through this helpful link to&nbsp;prepare for your interview.</li></ul><br><h4>PURPOSE OF JOB CLASS (NATURE OF WORK)</h4><br>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.<br><br>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.<br><h4>EXAMPLES OF DUTIES</h4><br><ul><li>Implements, coordinates, and evaluates activities of assigned programs or health care services;</li><li>Maintains active liaison with and serves as nursing consultant to other sections, divisions, health care providers and public;</li><li>Assesses safety and quality of client care provided;</li><li>Assesses compliance of health insurance companies with various state statutes, regulations and guidelines;</li><li>Provides consultation and reviews, evaluates and authorizes requests for medical placement services or equipment for clients covered under medical assistance programs;</li><li>Evaluates requests from health care providers asking to be included in medical assistance programs and offers consultation regarding interpretation of programs, policies and regulations;</li><li>May inspect and evaluate health care and psychiatric facilities for compliance with state and federal regulations including licensure and certification laws;</li><li>Performs related duties as required.</li></ul><br><h4>KNOWLEDGE, SKILL AND ABILITY</h4><br><ul><li>Considerable knowledge of    <ul><li>standards of care and service delivery in community based nursing agencies, licensed home health agencies, health care facilities and institutions;</li><li>relevant state and federal laws, statutes and regulations;</li><li>principles and practices of nursing care administration and education for a variety of specialties with varied settings;</li><li>principles and practices pertinent to community processes;</li></ul></li><li>Knowledge of    <ul><li>state, federal and local health agencies and programs;</li><li>nursing education and skill in techniques of teaching;</li></ul></li><li>Considerable    <ul><li>interpersonal skills;</li><li>oral and written communication skills;</li></ul></li><li>Ability to    <ul><li>plan, implement and evaluate programs;</li><li>collect and analyze data.</li></ul></li></ul><br><h4>MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE</h4><br>    Four (4) years of experience as a professional nurse in a position involving supervision, consultation, education or administration.<br><br>NOTE:&nbsp;<br><br><ul><li>Administrative capacity is interpreted as having managerial responsibility in setting and implementing policies, carrying out program planning, and evaluating and coordinating special projects, etc. in the area specified in the appropriate parenthetical title.</li><li>Consultative capacity is interpreted as the providing of professional expert nursing advice to other than subordinate staff on major programmatic issues in the area specified in the appropriate parenthetical title.</li><li>Educational capacity is interpreted as experience in a full time professional educational position instructing professional nurses in a formalized program or teaching students in an undergraduate or graduate nursing program in the area specified in the appropriate parenthetical title.</li><li>Supervisory capacity is interpreted as having administrative supervision of registered nurses or other professional staff.&nbsp;</li></ul><br><h4>MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE</h4><br>    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.   <br><h4>MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED</h4><br><ul><li>A Bachelor's degree in nursing may be substituted for one (1) year of the General Experience.</li><li>A Master's degree in health services administration, nursing or public health may be substituted for one (1) additional year of the General Experience.</li></ul><br><h4>PREFERRED QUALIFICATIONS</h4><br><ul><li>Experience and/or understanding of the CT Medicaid and Children’s Health Insurance program (CHIP) known as HUSKY Health.</li><li>Experience in planning healthcare program goals, objectives, and evaluation of health service achievements.</li><li>Experience in establishing connections, building community relationships, and serving as a liaison between department sections, divisions, healthcare providers, and the public.</li><li>Experience with national healthcare standards and measures such as Healthcare Effectiveness Data and Information Set (HEDIS), National Quality Forum (NQF), and Adult and Child Heath Quality (Core) Measures.</li><li>Experience interpreting federal and state statute, regulation, and policy to ensure Medicaid and CHIP policy is implemented appropriately.</li><li>Experience in utilizing and interpreting statistical data and other science-based tools to make data-driven decisions, with an understanding of under-represented voices in various data sets. </li><li>Experience with addressing race, gender, and social justice aspects of data science and its impact on community health.</li><li>Experience with fast-paced work environment, managing short deadlines, and quickly turning around documents; capable of handling multiple projects simultaneously, often requiring immediate attention.</li><li>Experience in developing value-based purchasing (VBP) initiatives and clinical projects.</li><li>Experience working independently to represent program initiatives and present data at both public and internal departmental meetings.</li></ul><br><h4>SPECIAL REQUIREMENTS</h4><br><ul><li>Incumbents in this class must possess and retain a current license as a registered professional nurse in Connecticut.</li><li>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.</li><li>Incumbents in this class may be required to travel.</li><li>Incumbents in this class may be required to possess and retain a valid Motor Vehicle Operator’s license.</li></ul><br><h4>Conclusion</h4><br><strong>AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER</strong><br><br>The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.<br><h4>ACKNOWLEDGEMENT</h4><br>    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.&nbsp; As such, a job class is not meant to be all-inclusive of every task and/or responsibility.   <br>

638 Social Services / Nursing Jobs