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Utilization Review Rn Jobs in New Haven, CT (NOW HIRING)

VITAS Healthcare

Registered Nurse (RN)

Clinton, CT · On-site

$44 - $48/hr

Registered Nurse, RN, develops and achieves professional growth goals and objectives personally and per Team Manager reviews * Registered Nurse, RN, responsible for attending orientation and ...

Yale NewHaven Health

RN; Registered Nurse

New Haven, CT · On-site

$60 - $80/hr

Resource Utilization: The RN utilizes appropriate resources to plan provide and sustain evidence-based nursing services that are safe, effective and fiscally responsible. Environmental Health: The RN ...

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Utilization Review Rn information

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$42

$69

How much do utilization review rn jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review rn in New Haven, CT is $42.52, according to ZipRecruiter salary data. Most workers in this role earn between $33.61 and $48.85 per hour, depending on experience, location, and employer.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

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

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are the most commonly searched types of Utilization Review Rn jobs in New Haven, CT?

The most popular types of Utilization Review Rn jobs in New Haven, CT are:

What are popular job titles related to Utilization Review Rn jobs in New Haven, CT?

For Utilization Review Rn jobs in New Haven, CT, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in New Haven, CT look for?

The top searched job categories for Utilization Review Rn jobs in New Haven, CT are:

What cities near New Haven, CT are hiring for Utilization Review Rn jobs?

Cities near New Haven, CT with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in New Haven, CT as of August 2026, with employment types broken down into 3% As Needed, 79% Full Time, 15% Part Time, and 3% Contract. Highlights an 88% In-person, and 12% Remote job distribution, with an average salary of $88,445 per year, or $42.5 per hour.

Utilization Review Nurse Coordinator (40 Hour)

State of Connecticut

Cheshire, CT • On-site

$122K/yr

Full-time

Posted 5 days ago

Job description

Introduction
Are you a dedicated Registered Nurse seeking a fulfilling role where you can truly impact the lives of individuals with disabilities? If so, we invite you to read more and apply today!
The State of Connecticut, Department of Developmental Services (DDS) - West Region Private Health Services is recruiting for one full-time Utilization Review Nurse Coordinator in Cheshire, CT.
New! We're excited that Connecticut has joined the Nurse Licensure Compact effective October 1, 2025. Visit Nurse Licensure Compact for more details. Incumbents in this class must possess a current license as a Registered Nurse (RN) in CT . You may verify your credentials in the Connecticut E-License Portal.
POSITION HIGHLIGHTS
  • PCN: 15975
  • SHIFT: First (1st) shift | Full-time | 80 hours biweekly
  • LOCATION: Cheshire, CT
  • SCHEDULE: Monday through Friday 8:00 AM - 4:30 PM
  • PLEASE NOTE: Work schedule flexibility is required in order to meet the demands of the job.

BENEFITS AND BALANCE AT THE STATE OF CONNECTICUT
What's In It For You:
Visit our new State Employee Benefits Overview page!
  • Professional growth and paid professional development opportunities.
  • A healthy work-life balance to all employees.
  • State of Connecticut is an eligible Public Service Loan Forgiveness employer, meaning you may be eligible to have qualifying student loan forgiveness after 10 years of service. Click here for more information.

Discover the opportunity to:
  • Engage in a rewarding career
  • Assist our employees so they can achieve success
  • Make a difference in the public sector
  • Work together in a collaborative team environment

ABOUT US
DDS partners with the individuals we support and their families, to support lifelong planning and to join with others to create and promote meaningful opportunities for individuals to fully participate as valued members of their communities.
YOUR ROLE
In your role as a Utilization Review Nurse Coordinator, you will have the opportunity to:
  • Coordinate Regional Mortality Review Committee activities; including scheduling meetings, obtaining and organizing pertinent healthcare information and medical records, and assisting with preparation of case materials for committee review.
  • Review and evaluate clinical, medical, and investigative documentation to identify concerns, trends, and areas requiring follow-up.
  • Collaborate with healthcare, regulatory, investigative, and community partners to obtain and evaluate clinical information necessary to support mortality review, quality assurance, and other departmental oversight activities.
  • Support clinical oversight, accountability, and quality assurance activities necessary to safeguard the health, safety, and welfare of individuals receiving DDS services.
  • Conduct clinical record audits and quality assurance reviews to evaluate adherence to applicable laws, regulations, policies, procedures, and professional standards.
  • Maintain mortality review data, case tracking systems, and related records to support timely case review, follow-up, reporting, and quality improvement activities.
  • Analyze clinical and quality data to identify trends, systemic concerns, and opportunities form improvements, with the goal of strengthening systems of care and reducing preventable adverse outcomes.
  • Assist in the development and implementation of corrective actions and quality improvement initiatives.
  • Support DDS compliance with applicable federal and state healthcare requirements.
  • Provide clinical and administrative support to the RHSD in carrying out mortality review and related oversight activities.
  • Participate in and provide clinical support to regional committees, review processes, and other clinical oversight activities as directed by the RHSD (Regional Health Services Director)
  • For a more comprehensive list of duties click here.

START WITH US. STAY WITH US. GROW WITH US.
Selection Plan
NEW: Check out our Applicant Tips on How to Apply!
Need more resources? Visit our Applicant Toolkit for additional support throughout the recruitment process.
FOR THOSE WHO HOLD AN RN LICENSE IN A STATE OTHER THAN CONNECTICUT AND DO NOT HOLD A MULTISTATE OR COMPACT REGISTERED NURSING LICENSE, AND WISH TO APPLY FOR A CONNECTICUT LICENSE, PLEASE:
  1. Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;
  2. Complete a CT DPH online application online (expand the 'Public Health Practitioners' grouping, select 'Registered Nurse' and then 'Start';
  3. Request verification of your out-of-state license(s) electronically through the National Council of State Boards of Nursing's : Nursys® System. To send verification of your license(s) to CT, read and agree to the terms, enter your biographic information, select your license type and select 'SEARCH'. Review the results and select the 'Next' button. Check the box next to 'Connecticut' and complete the transaction. Once the transaction is completed, you will receive a confirmation email from Nursys and the verification will be available to the DPH. Note that PA and MI verifications are not provided through Nursys. Please contact those state boards for information on obtaining verification.

FOR ASSISTANCE IN APPLYING:
Check out our Applicant Tips on How to Apply! Need more resources? Visit our Applicant Reference Library for additional support throughout the recruitment process.
BEFORE YOU APPLY:
  • Meet Minimum Qualifications: Ensure you meet the Minimum Qualifications listed on the job opening by the job closing date. You must specify your qualifications on your application. The minimum experience and training requirements listed must be met by the close date on the job opening, unless otherwise specified.
  • Educational Credits: List your earned credits and degrees from accredited institutions accurately on your application. To receive educational credits towards qualification, the institution must be accredited. If the institution of higher learning is located outside of the U.S., you are responsible for providing documentation from a recognized USA accrediting service which specializes in determining foreign education equivalencies to the contact listed below.
  • Resume Policy: Per Public Act 21-69, resumes are not accepted during the initial application process. As the recruitment process progresses, candidates may be required to submit additional documentation to support their qualification(s) for this position. This documentation may include: a cover letter, resume, transcripts, diplomas, performance reviews, attendance records, supervisory references, licensure, etc., at the request and discretion of the hiring agency.
  • Preferred Shift/Location: Select all location(s) and shift(s) you are willing to work on your application. Failure to do so may result in not being considered for vacancies in that specific location or shift.
  • Timely Submission: All application materials must be received by the job posting deadline. You will be unable to make revisions once you officially submit your application to the State. Late submissions are rarely accepted, with exceptions only for documented events that incapacitate individuals during the entire duration of the job posting. Request exceptions by emailing DAS.SHRM@ct.gov.
  • Salary Calculations: For current state employees, salary calculations are not necessarily comparable from one of the three branches of state government (i.e., Executive, Legislative, Judicial) to the other.
  • Note: The only way to apply to this posting is via the 'Apply' or 'Apply Online' buttons on the official State of Connecticut Online Employment Center job posting.

AFTER YOU APPLY:
  • Some email providers may experience delays or issues delivering messages. To avoid missing important updates-such as referral questionnaires or interview scheduling links-please check your Personal Status Board regularly. For added convenience, you can also enable text (SMS) notifications. To do this, log in to your Personal Status Board and select "Update My Contact Information."
  • Referral Questions: This posting may require completion of additional Referral Questions (RQs), which must be completed by the questionnaire's expiration date. If requested, RQs can be accessed via an email sent to you after the job close date or by visiting your JobAps Personal Status Board (Certification Questionnaires section).
  • Prepare For An Interview: Interviews are limited to those whose experience and training are most aligned with the role. To prepare, review this helpful Interview Preparation Guide to make the best impression!
  • Stay connected! Log in daily to your JobAps Personal Status Board to track your status and check email (including spam/junk folders) for updates and tasks.
  • The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.
  • Note: This position will be filled in accordance with contractual language, reemployment, SEBAC, transfer, promotion and merit employment rules. Candidates who are offered and accept a position with the State of Connecticut are bound by the State Code of Ethics for Public Officials and State employees, available at www.ct.gov/ethics.
  • This employer may participate in E-Verify and will provide the federal government with your Form I-9 information to confirm work authorization.

QUESTIONS? WE'RE HERE TO HELP:
Due to high volume, we are unable to confirm receipt or provide status updates directly. For recruitment updates, please check your Personal Status Board and review our Frequently Asked Questions. If you have additional questions about the recruitment process, reach out to at Samantha.Rivera@ct.gov.
Join the State of Connecticut and take your next career step with confidence!
If you require an accommodation to participate fully and fairly under the provisions of the Americans with Disabilities Act (ADA), please contact Edward Magnano, EEO Manager at (860) 418-6148 or (Edward.Magnano@ct.gov)
PURPOSE OF JOB CLASS (NATURE OF WORK)
In a state agency this class is accountable for coordinating a utilization review program which promotes effective cost recovery, quality of care and/or compliance with relevant federal and state laws, regulations and standards.
In the Department of Developmental Services this class is accountable for performing investigations of abuse, neglect and death in individuals with an intellectual disability including individuals under the care of the Department of Developmental Services.
EXAMPLES OF DUTIES
WORKING LEAD (REGULATORY):
  • Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of available services;
  • Schedules, assigns, oversees and reviews work;
  • Establishes and maintains program protocols and procedures;
  • Provides staff training and assistance;
  • Conducts or assists in conducting performance evaluations;
  • Acts as liaison with other operating units, agencies and outside officials regarding program policies and procedures;
  • Prepares reports and correspondence;
  • Assesses, evaluates and monitors documentation of all hospital disciplines when performing case reviews;
  • Attends professional workshops, seminars and in-service training;
  • May supervise Utilization Review Nurses and other staff engaged in review of medical records of individuals in state health care facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs;
  • May review medical records and compile documents for case presentations;
  • May provide pre-certification for and coordination of inmates admitted to and discharged from acute care facilities;
  • May lead an inspection team in IPR/UR and licensing review functions;
  • May conduct entrance and exit interviews of care providers;
  • May supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals on behalf of a facility relative to intermediate denials;
  • May testify in court;
  • May coordinate review and audit of occupational injury and/or disease disability cases for purpose of determining medical management, cost containment, peer review and rehabilitation;
  • May notify acute care hospitals of scheduled utilization review including conducting second level review of cases and case referral to a physician consultant for final disposition;
  • Performs related duties as required.
ADVANCED WORKING LEVEL (INVESTIGATORY):
  • Conducts complex investigations into allegations of abuse or neglect of individuals with an intellectual disability;
  • Conducts complex investigations into cases where a death has resulted of an individual with an intellectual disability for whom the Department of Developmental Services has direct or oversight responsibility for medical care;
  • Reviews medical care that was provided to individuals;
  • Assists in the investigation to determine if the death is a result of abuse or neglect;
  • Participates in the reviews of events, overall care, quality of life and medical care preceding a death;
  • Works cooperatively with State and local police, State's Attorneys and other protective services organizations;
  • Interviews alleged victims, direct care providers, families and other potential witnesses;
  • Prepares comprehensive, complex investigative reports;
  • Maintains records and documentation;
  • Reviews medical reco

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