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Utilization Review Rn Jobs in Newington, CT (NOW HIRING)

Connecticut Renaissance

Registered Nurse

Waterbury, CT · On-site

$47.43/hr

Registered Nurse Summary : * The Residential Registered Nurse (RN) position is responsible for ... utilization reviews as needed. * Collaborate with multidisciplinary team to on client care and ...

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 ...

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How much do utilization review rn jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for utilization review rn in Newington, CT is $42.09, according to ZipRecruiter salary data. Most workers in this role earn between $33.27 and $48.32 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 popular job titles related to Utilization Review Rn jobs in Newington, CT?

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Newington, CT as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 20% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $87,552 per year, or $42.1 per hour.

Utilization Management Registered Nurse RN

Hartford, CT

Trinityhealth
Health Care and Social Assistance • 10K+ employees

6.6

Company rating: 6.6 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

573rd of 895 rated healthcare providers

People enjoy working here

Recommended by students

Recommended by parents

Learn more about Trinityhealthexternal

Full-time

Posted 10 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.

Minimum Qualifications

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.

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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

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