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Utilization Management Associate Jobs in Wolcott, CT

Waterbury Hospital

Case Manager

Waterbury, CT · On-site

$20.50 - $26.25/hr

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 ...

Waterbury Hospital

Case Manager

Waterbury, CT · On-site

$20.50 - $26.25/hr

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 ...

Prime Therapeutics

Customer Care Associate I

Hartford, CT · On-site

$17.85 - $25.48/hr

Job Posting Title Customer Care Associate I The Customer Care Specialist is responsible for ... Utilization Management * Educate providers and members on claims submission, treatment plans ...

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Utilization Management Associate information

What does a utilization management associate do?

A Utilization Management Associate is responsible for reviewing healthcare services and determining whether they are medically necessary, appropriate, and efficient. They work with healthcare providers, insurance companies, and patients to ensure that treatments comply with established guidelines and policies. Their role often includes reviewing medical records, processing authorizations, and assisting in the coordination of care to optimize the use of healthcare resources. This position helps control costs while ensuring that patients receive the appropriate level of care.

What skills and qualifications are needed to thrive as a utilization management associate?

A Utilization Management Associate typically needs a background in healthcare administration or a related field, strong analytical skills, and knowledge of medical terminology and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and regulatory compliance systems is important, and certifications like Certified Professional in Healthcare Management (CPHM) can be advantageous. Attention to detail, effective communication, and strong organizational skills help associates excel in evaluating medical necessity and collaborating with care teams. These competencies ensure accurate, efficient review processes that support quality patient care and compliance with payer requirements.

What are the typical daily responsibilities of a utilization management associate?

Utilization Management Associates typically review medical records, verify insurance coverage, and coordinate with healthcare providers to ensure that treatments and services meet established guidelines and payer requirements. They also communicate with physicians and patients to gather necessary information for authorization requests. By ensuring appropriate utilization of healthcare resources, they help support patient care while managing costs and compliance for their organization. Collaboration with clinical staff and insurance representatives is a key part of the role, contributing to effective case management.

What is the difference between Utilization Management Associate vs Utilization Review Coordinator?

AspectUtilization Management AssociateUtilization Review Coordinator
CertificationsTypically requires a healthcare-related certification or licenseOften requires similar certifications, such as CCM or RHIA
Work EnvironmentWorks in insurance companies, healthcare providers, or managed care organizationsWorks in hospitals, insurance companies, or healthcare facilities
Job FocusAssists in reviewing medical necessity and authorization processesCoordinates and conducts utilization reviews and approvals
Common UsageUsed interchangeably in healthcare and insurance settingsOften used in hospital and insurance contexts

The Utilization Management Associate and Utilization Review Coordinator roles share similarities in certifications and work environments, focusing on reviewing medical necessity and authorization. The main difference lies in their specific responsibilities, with associates assisting in the process and coordinators actively conducting reviews and approvals.

Infographic showing various Utilization Management Associate job openings in Wolcott, CT as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 82% Physical, 2% Hybrid, and 16% Remote job distribution.

Case Manager

Waterbury, CT • On-site

Waterbury Hospital
Health Care and Social Assistance • 1 - 5K employees
Learn more about Waterbury Hospitalexternal

$20.50 - $26.25/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Waterbury Hospital rating

7.8

Company rating: 7.8 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

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:
  1. 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.
  2. 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.
  3. 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.
  4. Supports the effective prevention and management of denials, including drafting appeal letters and/or providing information as part of the appeal process.
  5. 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.
  6. 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.
  7. 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
  8. 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.
  9. Actively contributes to, participates in, and follows through on interventions identified in care coordination and complex patient rounds.
  10. Identifies high risk patients and creates a collaborative plan to address their unique needs.
  11. 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

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