Position Summary The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high ...
Position Summary The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high ...
Position Summary The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high ...
Position Summary The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high ...
Position Summary The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high ...
Position Summary The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high ...
RN Utilization Management - $60/hr - Hamden, CT
Hamden, CT · On-site
$60/hr
RN Utilization Management - $60/hr - Hamden, CT Hamden, Connecticut, United States Or refer someone Job Openings RN Utilization Management - $60/hr - Hamden, CT About the Job RN Utilization ...
RN Utilization Management - $60/hr - Hamden, CT
Hamden, CT · On-site
$60/hr
RN Utilization Management - $60/hr - Hamden, CT Hamden, Connecticut, United States Or refer someone Job Openings RN Utilization Management - $60/hr - Hamden, CT About the Job RN Utilization ...
Utilization Management Assoc / Clinical Resource Management
Wethersfield, CT · On-site
$65K - $90K/yr
Utilization Management Assoc / Clinical Resource Management Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: pride in ...
New
Utilization Management Assoc / Clinical Resource Management
Wethersfield, CT · On-site
$65K - $90K/yr
Utilization Management Assoc / Clinical Resource Management Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: pride in ...
New
Utilization Management Assoc / Clinical Resource Management
Wethersfield, CT · On-site
$65K - $89K/yr
Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
Utilization Management Assoc / Clinical Resource Management
Wethersfield, CT · On-site
$65K - $89K/yr
Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
Utilization Management Assoc / Clinical Resource Management
Wethersfield, CT · On-site
$65K - $89K/yr
Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
Utilization Management Assoc / Clinical Resource Management
Wethersfield, CT · On-site
$65K - $89K/yr
Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization Management list, Discharge Log, and the Discharge Disposition report for payers.
Position Details The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity ...
Position Details The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity ...
Position Details The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity ...
Position Details The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity ...
Position Details The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity ...
Position Details The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity ...
Utilization Management Representative I - Backoffice Support
Wallingford, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Utilization Management Representative ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Utilization Management Representative I - Backoffice Support
Wallingford, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Utilization Management Representative ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Utilization Management Representative I - Backoffice Support
Wallingford, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum ...
Utilization Management Representative I - Backoffice Support
Wallingford, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Location: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum ...
Manager, Clinical Resource Management Qualifications: Education: Registered Nurse. Bachelors of Science in Nursing is preferred. Experience: Five years of relevant case management, utilization ...
Manager, Clinical Resource Management Qualifications: Education: Registered Nurse. Bachelors of Science in Nursing is preferred. Experience: Five years of relevant case management, utilization ...
Utilization Management Representative I - Backoffice Support
Wallingford, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Location : This role enables ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Utilization Management Representative I - Backoffice Support
Wallingford, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Location : This role enables ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Utilization Management Representative I - Backoffice Support
Meriden, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Location : This role enables ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
New
Utilization Management Representative I - Backoffice Support
Meriden, CT · On-site
$17 - $21.75/hr
Utilization Management Representative I - Backoffice Support Location : This role enables ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
New
Educate physicians and clinical teams on utilization management best practices, documentation, and evolving regulatory standards. Participate in quality improvement initiatives that enhance patient ...
Educate physicians and clinical teams on utilization management best practices, documentation, and evolving regulatory standards. Participate in quality improvement initiatives that enhance patient ...
This physician leader serves as a clinical resource for utilization management, level of care determinations, regulatory compliance, and physician education. The ideal candidate combines strong ...
This physician leader serves as a clinical resource for utilization management, level of care determinations, regulatory compliance, and physician education. The ideal candidate combines strong ...
This physician leader serves as a clinical resource for utilization management, level of care determinations, regulatory compliance, and physician education. The ideal candidate combines strong ...
This physician leader serves as a clinical resource for utilization management, level of care determinations, regulatory compliance, and physician education. The ideal candidate combines strong ...
Demonstrates current knowledge of Nurse Case Manager, Utilization Review Nurse, and Social Work activities as appropriate and seeks professional help when unfamiliar with specific regulations or ...
Demonstrates current knowledge of Nurse Case Manager, Utilization Review Nurse, and Social Work activities as appropriate and seeks professional help when unfamiliar with specific regulations or ...
The Team Lead for Utilization Review (UR) is responsible for the day-to-day activities and ... Work with Manager to establish and track metrics, data and initiatives that improve process * UR ...
The Team Lead for Utilization Review (UR) is responsible for the day-to-day activities and ... Work with Manager to establish and track metrics, data and initiatives that improve process * UR ...
Manager Utilization Management information
What does a manager utilization management do?
A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the key skills and qualifications needed to thrive as a manager utilization management?
To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.
What are some common challenges faced by a manager utilization management, and how can they effectively address them?
Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.
What is the difference between Manager Utilization Management vs Utilization Review Nurse?
| Aspect | Manager Utilization Management | Utilization Review Nurse |
|---|---|---|
| Credentials | RN, often with management or utilization review certifications | RN, with certifications in utilization review or case management |
| Work Environment | Supervises teams, manages policies, oversees utilization review processes | Performs patient chart reviews, assesses medical necessity, collaborates with providers |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Hospitals, insurance companies, healthcare organizations |
| Search & Comparison Intent | Yes | Yes |
While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.
What are the most commonly searched types of Utilization Management jobs in Connecticut?
The most popular types of Utilization Management jobs in Connecticut are:
What are popular job titles related to Manager Utilization Management jobs in Connecticut?
For Manager Utilization Management jobs in Connecticut, the most frequently searched job titles are:
- Utilization Management Nurse
- Weekend Physician Advisor Utilization Review
- Full Time Optum Health Utilization Review
- Manager Care Management
- Per Diem Utilization Review Nurse
- Part Time Utilization Review Nurse
- Remote Utilization Review Nurse
- Remote Utilization Management
- Independent Contractor Remote Utilization Management Nurse
- Non Clinical Utilization Review
What job categories do people searching Manager Utilization Management jobs in Connecticut look for?
The top searched job categories for Manager Utilization Management jobs in Connecticut are:
- Remote Weekend Utilization Review
- Remote Optum Utilization Review
- Optum Utilization Review Nurse
- Utilization Review
- Remote Cigna Utilization Review Nurse
- Locum Medical Utilization Review Physician
- Senior Specialist Cigna Utilization Review
- Coordinator Aetna Utilization Review
- Weekend Utilization Review
- Remote Aetna Utilization Review
What cities in Connecticut are hiring for Manager Utilization Management jobs?
Cities in Connecticut with the most Manager Utilization Management job openings:
Utilization Management Registered Nurse RN
Hartford, CT
Trinity Health •
Health Care and Social Assistance • 10K+ employees10,000+ employees
6.6
Based on 354 frontline employees who took The Breakroom Quiz
570th of 893 rated healthcare providers
People enjoy working here
Recommended by students
Recommended by parents
Respectful managers
Good training
Full-time
Posted 4 days ago
Job description
Employment Type:Full timeShift:Day ShiftDescription:
Position Summary
The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high-quality patient care. Using established clinical guidelines, regulatory requirements, and health plan policies, the UM RN collaborates with providers, interdisciplinary care teams, and patients to support optimal health outcomes while promoting the efficient use of healthcare resources.
Key Responsibilities
Conduct concurrent utilization reviews to determine and validate the appropriate level of care using established criteria, including InterQual and Milliman guidelines.
Initiate, manage, and track admission authorizations and payer communications.
Review and monitor insurance denials, support appeals processes, and identify opportunities for utilization management process improvements.
Collaborate with physicians, case managers, and interdisciplinary care teams to optimize care plans and facilitate timely, effective discharge planning.
Ensure clinical documentation accurately reflects severity of illness, medical necessity, and appropriate resource utilization.
Partner with Finance, Health Information Management (HIM), Admitting, and other key departments to support utilization management activities and organizational goals.
Work closely with care coordination teams to promote high-quality, patient-centered, and cost-effective outcomes.
Maintain compliance with regulatory, accreditation, and payer requirements.
Required
Graduate of an accredited School of Nursing.
Current, unrestricted Connecticut Registered Nurse (RN) license.
Preferred
Bachelor of Science in Nursing (BSN).
Three (3) or more years of Utilization Management, Utilization Review, Case Management, or related experience in an acute care hospital setting.
Experience utilizing InterQual and/or Milliman clinical criteria.
Position Highlights
Full-time, 40 hours per week
Hybrid work schedule
About Saint Francis Hospital
Saint Francis Hospital has been a trusted healthcare leader in Connecticut since 1897. As a member of Trinity Health Of New England and Trinity Health, one of the nation's largest Catholic healthcare systems, Saint Francis is committed to delivering exceptional patient care, advancing medical innovation, and serving the community. Saint Francis Hospital is a 617-bed Level I Trauma Center and major teaching hospital offering a comprehensive range of specialized services. Notable programs and affiliated entities include the Comprehensive Women's Health Center, the Connecticut Joint Replacement Institute, and Smilow Cancer Hospital. Through a commitment to excellence, compassion, and innovation, Saint Francis continues to provide high-quality care to patients across the region.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
About Trinity Health
Sourced by ZipRecruiter
Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Livonia, MI, US
Website
What Trinity Health employees say
Pay
Benefits
Hours and flexibility
Workplace
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