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Utilization Case Manager Jobs in Connecticut (NOW HIRING)

Yale New Haven Health

Case Manager

New Haven, CT · On-site

$20 - $26/hr

Utilization management and case management experience preferred. Knowledge of computer software and hardware applications and a basic knowledge of statistics. PHYSICAL DEMAND 50% sedentary; sitting ...

Encompass Health

Case Manager

Danbury, CT

$20.50 - $26.25/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Yale NewHaven Health

Case Manager

New Haven, CT · On-site

$20 - $26/hr

Utilization management and case management experience preferred. Knowledge of computer software and hardware applications and a basic knowledge of statistics. PHYSICAL DEMAND 50% sedentary; sitting ...

Yale New Haven Health

Case Manager

New Haven, CT · On-site

$20 - $26/hr

Utilization management and case management experience preferred. Knowledge of computer software and hardware applications and a basic knowledge of statistics. PHYSICAL DEMAND 50% sedentary; sitting ...

Yale New Haven Health

Case Manager

New Haven, CT · On-site

$20 - $26/hr

Utilization management and case management experience preferred. Knowledge of computer software and hardware applications and a basic knowledge of statistics. PHYSICAL DEMAND 50% sedentary; sitting ...

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Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in Connecticut?

For Utilization Case Manager jobs in Connecticut, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Connecticut look for?

The top searched job categories for Utilization Case Manager jobs in Connecticut are:

What cities in Connecticut are hiring for Utilization Case Manager jobs?

Cities in Connecticut with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you
Infographic showing various Utilization Case Manager job openings in Connecticut as of September 2026, with employment types broken down into 17% As Needed, and 83% Full Time. Highlights an 100% In-person job distribution.

Case Manager

New Haven, CT • On-site

Yale New Haven Health
Health Care and Social Assistance • 10K+ employees
Learn more about Yale New Haven Healthexternal

$20 - $26/hr

Full-time

Re-posted 21 days ago

Yale New Haven Health rating

7.4

Company rating: 7.4 out of 10

Based on 233 frontline employees who took The Breakroom Quiz

Job description

Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The Case Manager is responsible and accountable for ensuring high-value patient care that is coordinated, efficient, and aligned with institutional clinical and financial objectives. In collaboration with the healthcare team, the Case Manager utilizes evidence-based practice to ensure that specific patient outcomes are reliably achieved and that resources are appropriately used within designated fiscal time frames. With our members of the health care team, the Case Manager participates in the ongoing evaluation of practice patterns and supports efforts to improve patient care and enhance the efficiency of operations. The Case Manager interacts with others in the identification of trends and barriers to all aspects of care. Through this interaction, the Case Manager identifies and works toward a resolution as a part of the multidisciplinary team.
EEO/AA/Disability/Veteran
Responsibilities
  • 1. As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management.
    • 1.1 Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services, and case management.
  • 2. Optimizes the efficiency of hospital systems which impact quality and/or length of stay
    • 2.1 Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan.
  • 3. Utilizes information obtained from various resources available to:
    • 3.1 Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team.
  • 4. Assist clinicians in documenting the appropriateness of admissions and continued stays
    • 4.1 Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials.
  • 5. Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include:
    • 5.1 Identifying service, treatment, and funding options;
  • 6. Ensures that the discharge plan provides a continuum of care with the appropriate outpatient physician and needed services.
  • 7. Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through.
    • 7.1 Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum.
  • 8. Works collaboratively with PSM and unit leadership team to actively involve clinical nurses in the assessment and planning for patient's discharge to facility.
  • 9. Along with other members of the health care team, acts as a patient advocate.
    • 9.1 Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk.

Qualifications
EDUCATION
Minimum of a Baccalaureate degree in clinically related field. R.N. required
EXPERIENCE
Minimum of three (3) years of relevant clinical experience
LICENSURE
Active RN Licensure in Connecticut
SPECIAL SKILLS
Recent appropriate nursing experience, theoretical knowledge of the nursing process, case management and continuity of care. Advanced communication and interpersonal skills with all levels of internal and external customers. Ability to obtain and interpret information appropriate to patient needs and age. Advanced assessment and teaching skills. Leadership skills in planning and managing patient care as acquired through greater than 3 years of clinical nursing experience in an acute care hospital. Utilization management and case management experience preferred. Knowledge of computer software and hardware applications and a basic knowledge of statistics.
PHYSICAL DEMAND
50% sedentary; sitting, standing, walking from unit to unit, carrying records, speaking before groups. Must be able to speak and hear in a manner understood by most people. Must be able to communicate effectively by telephone.
YNHHS Requisition ID
186179

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