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

CVS Health

Case Manager, Registered Nurse

Hartford, CT · Remote

$54K - $155K/yr

A RN who resides in a compact state is required to have an active multistate license through the ... Utilization Review. * CCM and/or other URAC recognized accreditation preferred. * 1+ years ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Vernon, CT

Utilization Review Rn information

See Vernon, CT salary details

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$42

$68

How much do utilization review rn jobs pay per hour?

As of Jun 13, 2026, the average hourly pay for utilization review rn in Vernon, CT is $42.26, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.51 per hour, depending on experience, location, and employer.

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.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

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 does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

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.
What are popular job titles related to Utilization Review Rn jobs in Vernon, CT? For Utilization Review Rn jobs in Vernon, CT, the most frequently searched job titles are:
What cities near Vernon, CT are hiring for Utilization Review Rn jobs? Cities near Vernon, CT with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Vernon, CT as of June 2026, with employment types broken down into 88% Full Time, 9% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $87,902 per year, or $42.3 per hour.

Utilization Review Nurse Coordinator (40 Hour)

State of Connecticut - Department of Children & Families

Middletown, CT

Full-time

Posted 2 days ago

Job description

Introduction

\r\n\r\n\r\n\r\n\r\nThe State of Connecticut, Department of Children and Families (DCF) - Albert J. Solnit Children's Center, South Campus Hospital - is accepting applications for a Utilization Review Nurse Coordinator(Regulatory) position, located in Middletown, CT.\r\n\r\n\r\nWe welcome you to be a part of a comprehensive team of caring professionals and assist our clients/patients so they can achieve success. You will experience the opportunity to make a difference in the public sector as well as Make an ImpaCT as a Registered Professional Nurse for the state of Connecticut! We encourage you to apply today!\r\n\r\n\r\nNew: We're excited that Connecticut has joined the Nurse Licensure Compact effective October 1, 2025. Visit Nurse Licensure Compact for more details.\r\n\r\n\r\nPosition Highlights:\r\n\r\n\r\n PCN 96219\r\n Full-time | 1st shift\r\n Monday - Friday | 8:00 am - 4:30 pm\r\n Employees new to state service will start at minimum\r\n Middletown, CT\r\n\r\nIn your role as a Utilization Review Nurse Coordinator, you will have the opportunity to:\r\n\r\n\r\n Coordinate workflow and determine priorities to assure the delivery of the highest quality of care with efficient utilization of available services\r\n Schedule, assign, oversee and review work\r\n Establish and maintain program protocols and procedures\r\n Provide staff training and assistance\r\n Act as liaison with other operating units, agencies and outside officials regarding program policies and procedures\r\n Prepare reports and correspondence\r\n Assess, evaluate and monitor documentation of all hospital disciplines when performing case reviews\r\n Attend professional workshops, seminars and in-service training\r\n Perform related duties as required.\r\n For a more comprehensive list of duties click here.\r\n\r\n\r\n\r\nAbout Us:\r\n\r\nAt the Albert J. Solnit Children's Center, we treat our youth and each other with dignity and respect. It is in this relational, cultural and gender sensitive surrounding that our therapeutic milieu is based. Interdisciplinary teams develop, implement and continually assess individualized treatment plans.\r\n\r\n\r\nSolnit - South Campus is a state-administered Psychiatric facility for Connecticut's youth who are under the age of eighteen, located on a 67-acre campus overlooking the Connecticut River in Middletown, CT. The campus includes four coed hospital units and three female adolescent Psychiatric Residential Treatment Facility (PRTF) cottages. The Utilization Review Nurse Coordinator position is located at Solnit Hospital. The Solnit Hospital provides comprehensive care to children and adolescents with severe mental illness and related behavior and emotional problems who cannot be safely assessed or treated in a less restrictive setting.\r\n\r\n\r\nThe campus includes: Four coed hospital units, three female adolescent Psychiatric Residential Treatment Facility cottages (PRTF), two schools, an indoor pool, playgrounds, ball field, two gyms, recreation rooms, and outdoor picnic area.\r\n\r\n\r\n\r\nWe welcome you to be a part of a comprehensive team of caring professionals and assist our clients/patients so they can achieve success. You will experience the opportunity to make a difference in the public sector as a Utilization Review Nurse Coordinator (Regulatory) for the state of Connecticut!\r\n\r\n\r\nNew: Check out what a career as a Nurse with DCF could look like for you!\r\n\r\n\r\n\r\n\r\nWhat's In It For You:\r\n\r\nVisit our State Employee Benefits Overview page!\r\n\r\n\r\n Professional growth and paid professional development opportunities.\r\n A healthy work-life balance to all employees.\r\n 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.\r\n\r\n\r\nDiscover the opportunity to:\r\n\r\n\r\n Engage in a rewarding career\r\n Assist our employees so they can achieve success\r\n Make a difference in the public sector\r\n Work together in a collaborative team environment\r\n\r\nAbout the State of Connecticut:\r\n\r\nLiving in Connecticut allows you to live with mountains, forests, ocean fronts, rivers, and a wonderful green countryside right at your doorstep. The state has charm, elegance, and a high standard of living. Our school systems offer an outstanding education, and our communities are among the safest in the country. Connecticut experiences all four seasons and gives you the option to choose living in sophisticated country-life or living in the center of a lively city.\r\n\r\n\r\nWe encourage you to come see all that Connecticut has to offer by joining the DCF team!\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n

Selection Plan

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:\r\n\r\n\r\n Review the eligibility and documentation requirements for CT license by endorsement of an out-of-state license;\r\n Complete a CT DPH online application online (expand the 'Public Health Practitioners' grouping, select 'Registered Nurse' and then 'Start';\r\n 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.\r\n\r\nFOR ASSISTANCE IN APPLYING:\r\nCheck out our Applicant Tips on How to Apply! Need more resources? Visit our Applicant Reference Library for additional support throughout the recruitment process.\r\nBEFORE YOU APPLY:\r\n\r\n 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.\r\n 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.\r\n 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.\r\n 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.\r\n 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.\r\n 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.\r\n\r\n\r\n 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.\r\n\r\nAFTER YOU APPLY:\r\n\r\n 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).\r\n 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!\r\n 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.\r\n The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.\r\n 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.\r\n\r\nQUESTIONS? WE'RE HERE TO HELP:\r\nDue 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 Ethan Ives at Ethan.Ives@ct.gov.\r\n\r\nJoin the State of Connecticut and take your next career step with confidence!\r\n

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.\r\nIn 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.\r\n

EXAMPLES OF DUTIES

WORKING LEAD (REGULATORY):\r\n\r\n\r\n Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of available services;\r\n Schedules, assigns, oversees and reviews work;\r\n Establishes and maintains program protocols and procedures;\r\n Provides staff training and assistance;\r\n Conducts or assists in conducting performance evaluations;\r\n Acts as liaison with other operating units, agencies and outside officials regarding program policies and procedures;\r\n Prepares reports and correspondence;\r\n Assesses, evaluates and monitors documentation of all hospital disciplines when performing case reviews;\r\n Attends professional workshops, seminars and in-service training;\r\n 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;\r\n May review medical records and compile documents for case presentations;\r\n May provide pre-certification for and coordination of inmates admitted to and discharged from acute care facilities;\r\n May lead an inspection team in IPR/UR and licensing review functions;\r\n May conduct entrance and exit interviews of care providers;\r\n May supervise and participate in hospital Medicare and Medicaid reimbursement programs including preparation of appeals on behalf of a facility relative to intermediate denials;\r\n May testify in court;\r\n 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;\r\n 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;\r\n Performs related duties as required.\r\n\r\nADVANCED WORKING LEVEL (INVESTIGATORY):\r\n\r\n\r\n Conducts complex investigations into allegations of abuse or neglect of individuals with an intellectual disability;\r\n 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;\r\n Reviews medical care that was provided to individuals;\r\n Assists in the investigation to determine if the death is a result of abuse or neglect;\r\n Participates in the reviews of events, overall care, quality of life and medical care preceding a death;\r\n Works cooperatively with State and local police, State's Attorneys and other protective services organizations;\r\n Interviews alleged victims, direct care providers, families and other potential witnesses;\r\n Prepares comprehensive, complex investigative reports;\r\n Maintains records and documentation;\r\n Reviews medical records for pertinent information related to investigations;\r\n May provide information and assistance to the Independent Mortality Review Board or Fatality Review Board for Persons with Disabilities;\r\n May testify in court proceeding;\r\n Performs related duties as required.\r\n\r\nDEPARTMENT OF VETERANS AFFAIRS:\r\n\r\n\r\n Coordinates activities of care team, plans and schedules meetings, tracks input and attendance;\r\n Ensures outcome of process is accurate document for care planning;\r\n Audits process according to utilization guidelines and ensures process is completed within appropriate regulatory time frames;\r\n Trains all Health Care Team members on Resident Assessment Instrument (RAI) care planning system;\r\n Acts as resource to all areas involved in Minimum Data Set (MDS) process;\r\n Ensures compliance with state statutes, federal Veterans Affairs regulations and state Department of Veterans Affairs policies and procedures;\r\n Monitors and manages timely electronic transmission of MDS program data;\r\n Routinely conducts chart audits and maintains log of deficiencies and discrepancies;\r\n Identifies errors in coding of MDS and R...

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