Case Manager
Waterbury, CT · On-site
$20.50 - $26.25/hr
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Case Manager
Waterbury, CT · On-site
$20.50 - $26.25/hr
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Case Manager
$20.50 - $26.25/hr
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Case Manager
$20.50 - $26.25/hr
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Case Manager
$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 ...
Case Manager
$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 ...
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 ...
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 ...
Case Manager
$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 ...
Case Manager
$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 ...
Case Manager
$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 ...
Case Manager
$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 ...
Case Manager
$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 ...
Case Manager
$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 ...
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 ...
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 ...
Case Manager
$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 ...
Case Manager
$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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Clinical Case Manager
Waterbury, CT · On-site
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Clinical Case Manager
Waterbury, CT · On-site
Has overall accountability for the utilization management and transition management for patients ... Case Management certification preferred
Case Manager
Hartford, CT · On-site
As a DDS Case Manager, you would be coordinating and performing case management for Day Services ... Monitors utilization rates to ensure that participant needs are met. * Schedules and supervises ...
Quick apply
Case Manager
Hartford, CT · On-site
As a DDS Case Manager, you would be coordinating and performing case management for Day Services ... Monitors utilization rates to ensure that participant needs are met. * Schedules and supervises ...
Works under the direction of the Manager of Continuing Care and Utilization Management and in ... Case management experience preferred. LICENSURE/CERTIFICATION * Current license as a registered ...
Works under the direction of the Manager of Continuing Care and Utilization Management and in ... Case management experience preferred. LICENSURE/CERTIFICATION * Current license as a registered ...
DDS Case Manager
Bridgeport, CT · On-site
$19/hr
As a DDS Case Manager, you would be coordinating and performing case management for residential ... Monitors utilization rates to ensure that participant needs are met. * Schedules and supervises ...
Quick apply
DDS Case Manager
Bridgeport, CT · On-site
$19/hr
As a DDS Case Manager, you would be coordinating and performing case management for residential ... Monitors utilization rates to ensure that participant needs are met. * Schedules and supervises ...
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 does a utilization case manager do?
A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.
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 jobs pay 4000 a week without a degree?
Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.
What is the highest paid case manager?
The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.
Is being a MOA a good entry level job?
A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.
What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?
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.
What is the difference between Utilization Case Manager vs Utilization Review Nurse?
| Aspect | Utilization Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | RN license, case management certification | RN license, certification in utilization review |
| Work Environment | Case management teams, hospitals, insurance companies | Utilization review departments, hospitals, insurance providers |
| Primary Focus | Coordinating patient care, discharge planning, resource allocation | Assessing medical necessity, reviewing patient records for appropriateness |
| Common Usage | Broader case management roles, patient advocacy | Specific 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 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:
- Utilization Management
- Entry Level Behavioral Health Case Manager
- Remote Telephonic Nurse
- Remote Cvs Utilization Management Nurse
- Telephonic Nurse Case Manager
- Evening Remote Telephonic Nurse Case Manager
- Behavioral Health Case Manager
- 3Rd Shift Behavioral Health Utilization Review
- Psych Case Manager
- Hospital Case Management
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:
Waterbury Hospital rating
7.8
Based on 8 frontline employees who took The Breakroom Quiz
160th of 1,054 rated hospitals
Job description
SCOPE OF POSITION:
Under the general supervision of the Director, nurses in the Case Manager role provide clinically-based case management to support the delivery of effective and efficient patient care. Paces cases from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned caseload. Partners with Social Workers and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement. Utilizes criteria to confirm medical necessity for admission and continued stay. With the patient, family and health care team, creates a discharge plan appropriate to the patient's needs and resources.
RESPONSIBILITIES:
REQUIREMENTS:
families.
Under the general supervision of the Director, nurses in the Case Manager role provide clinically-based case management to support the delivery of effective and efficient patient care. Paces cases from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned caseload. Partners with Social Workers and collaborates with other health care team members to identify appropriate utilization of resources and to ensure reimbursement. Utilizes criteria to confirm medical necessity for admission and continued stay. With the patient, family and health care team, creates a discharge plan appropriate to the patient's needs and resources.
RESPONSIBILITIES:
- Determines medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria, and third party information. Intervenes when determinations are not in alignment with clinical information, clinical criteria or third party information to resolve the situation. Documents information in the current electronic medical record and designated databases.
- Validates admission and continuing stay criteria with third party payers (including onsite and telephonic Case Managers) as well as Primary Care and Attending Physicians. Recommends alternative care sites where appropriate.
- Collaborates with the third party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial. Intervenes to prevent the denial where possible.
- Supports the effective prevention and management of denials, including drafting appeal letters and/or providing information as part of the appeal process.
- Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge.
- Collaborates and communicates with patients/families related to reimbursement issues and to create a discharge plan. Supports the process of patient choice in establishing a discharge plan.
- Uses clinical knowledge and knowledge of anticipate response to treatment to assess patient progression towards anticipated outcomes. Communicates and coordinates with the patient/family and health care team to Intervene when progression is stalled or diverted. Addresses actual/potential barriers to discharge
- Completes the interventions necessary for discharges to home with self-care, home with services and short term skilled nursing facility placement. Assembles necessary referrals, discharge summaries and pertinent information for placement prior to the day of discharge.
- Actively contributes to, participates in, and follows through on interventions identified in care coordination and complex patient rounds.
- Identifies high risk patients and creates a collaborative plan to address their unique needs.
- Key stake holder in the patient throughput process, supports safe and expeditious transition of patients.
REQUIREMENTS:
- Strong interpersonal, communication, and negotiation skills.
- Ability to form positive, collaborative relationships with hospital staff, patients and
families.
- Ability to effectively negotiate with internal and external providers of patient care services.
- Analytical abilities to assist in obtaining solutions to problems.
- Able to work independently and prioritize work.
- Able to manage multiple priorities.
- Basic knowledge of computers and clinical applications.
- Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.
- Communicate in a clear, concise, and logical manner in oral and written presentations.
- Minimum of 5 years of broad clinical experience, predominately in medical/surgical nursing.
- Case Management, discharge planning and utilization review experience preferred.
- Licensed as a Registered Nurse in the State of Connecticut.
- Graduate nursing program ( Diploma/Associates) BSN preferred or actively working towards BSN.
- Case Management certification preferred
What Waterbury Hospital employees say
Pay
Hours and flexibility
Workplace
Get the full story on Breakroom
About Waterbury Hospital
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Waterbury, CT, US
Year founded
1890