TENTATIVE  

Occ. Code 5513300

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

            Senior Utilization Review Nurses review health care provided to persons in the direct or indirect custody and care of New York State or local governments to determine appropriate usage of services.  Positions in this class are located at the Department of Corrections and Community Supervision (DOCCS), at certain facilities and in Main Office; the State Commission of Correction (SCOC); and the Office of Children and Family Services (OCFS).  The supervisory class in this series only is found at DOCCS.

DISTINGUISHING CHARACTERISTICS

            SENIOR UTILIZATION REVIEW NURSE:  under the general supervision of appropriate higher-level staff (which varies by agency), a Senior Utilization Review Nurse reviews, monitors, and analyzes the quality and cost of health care provided to persons in the direct or indirect custody and care of New York State or local governments.  (Examples of such persons include inmates of State or local prisons or jails, and youth confined due to adjudication as juvenile delinquent or person in need of supervision.) They determine appropriate quality of care and appropriate use of resources.  They may take actions to improve either or both, depending on employing agency and assignment.  Incumbents have substantial contact with other medical professionals and some contact with individuals in care or custody.

          SUPERVISOR CORRECTIONAL HEALTH SERVICES UTILIZATION MANGEMENT: under the general direction of higher-level staff at DOCCS, an incumbent develops and implements a system designed to monitor the utilization of all aspects of the Departments health facility resources, working collaboratively with various parties.  This class is found only at DOCCS.

RELATED CLASSES

          Nurses 2 are registered nurses.  They plan, provide, and supervise nursing interventions for individuals in State facilities or otherwise under the custody or in the care of New York State.  This class is found at various agencies.

          Nurse Administrators 1 are registered nurses responsible for directing nursing services within a defined unit, facility, infirmary, or other such location; or for a defined group of patients.  This class is found at various agencies.

          Infection Control Nurses supervise the infection control program and related activities in a hospital, intermediate care facility, or any clinical setting.  This class is found at various agencies.

          Utilization Review Coordinators serve as part of a team responsible for developing quality improvement monitoring criteria.  They conduct mandated quality assurance client chart reviews and follow up on identified deficiencies to ensure proper patient care. Incumbents may supervise various lower-level support staff and work under the direct supervision of the Quality Management Director.  This class is found at the Office of Mental Health and the Office for People with Developmental Disabilities.

ILLUSTRATIVE DUTIES

          SENIOR UTILZATION REVIEW NURSE

Ensures the delivery of health care to inmates or others within State care or custody (or other similar parties) is consistent with applicable professional and community standards, is cost effective, and uses resources appropriately.

Works with, meets with, and/or serves as a liaison to, other staff from the employing agency, and/or the staff of other agencies, and/or distinct organizational units of the employing agency, and/or parties outside of State service (such as other medical professionals), as is needed and appropriate. 

Evaluates discharge planning processes and procedures for effectiveness, and provides appropriate input.

Coordinates with other staff in the area of discharge planning.

Provides education for other staff in the area of discharge planning.

Identifies available resources and appropriate placements (including participating in the offender classification process).  Coordinates use of such resources and the making of such placements.

When employed at DOCCS may be responsible for certain programs impacting inmates who are facing terminal or permanent illness, and are determined not to be a threat to the public, to be released to the community for purposes of medical care.

When employed at SCOC manages an inmate mortality and special medical investigations caseload to monitor the provision of health care to inmates in state and local correctional facilities.  Performs site visits and review documents, authors various related reports and other documents, designs minimum health services staffing plans as appropriate, and performs various other specific duties related to the primary functions.

When employed at OCFS monitors, coordinates, provides technical assistance, and provides quality assurance to all OCFS facility health programs (including the reception centers); provides training (directly or by assisting other trainers) to facility staff with regards to health issues; and performs various other specific duties related to the primary functions.

          SUPERVISOR CORRECTIONAL HEALTH SERVICES UTILIZATION MANAGEMENT

Monitors and evaluates the utilization of DOCCSs health services resources, including developing minimum operating standards, ensuring that period site visits are made for monitoring purposes, identifying major problem areas, and making recommendations for improvement.

Supervises Senior Utilization Review Nurses and other lower-level staff employed within DOCCSs utilization review operation.

Directs and coordinates transfers and placements through inter- and intra-departmental and community hospital placements.

Performs various supervisory and management functions related to discharge planning.

Performs fact-finding functions in the evaluation of health care at a given facility or within a given aspect of DOCCSs health care operation, including identifying specific potential deficiencies, identifying system-wide problems, and developing and implementing solutions.

MINIMUM QUALIFICATIONS

          SENIOR UTILIZATION REVIEW NURSE

Open Competitive: must be licensed and currently registered to practice nursing in New York State. In addition, must have two years of post-RN licensure hospital nursing experience of which one year was dedicated to utilization review and/or discharge planning.  Qualifying experience in utilization review and/or discharge planning may also include audits, quality assurance, risk assessment, and/or policy revision. 

          SUPERVISOR CORRECTIONAL HEALTH SERVICES UTILIZATION MANGEMENT

Promotion: three years as a Senior Utilization Review Nurse, Infection Control Nurse, or Nurse Administrator within DOCCS.

Date:  3/16

NOTE:  Classification Standards illustrate the nature, extent, and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.