Oversee utilization management processes, levelofcare determinations, concurrent reviews, denials ... Active Registered Nurse (RN) license in Connecticut * BSN required ; MSN or Master's in related ...
Oversee utilization management processes, levelofcare determinations, concurrent reviews, denials ... Active Registered Nurse (RN) license in Connecticut * BSN required ; MSN or Master's in related ...
Performs chart review of assigned patients to identify quality, timeliness, and appropriateness of ... Pediatric nursing experience * Previous experience in Utilization Review * Previous experience in ...
Performs chart review of assigned patients to identify quality, timeliness, and appropriateness of ... Pediatric nursing experience * Previous experience in Utilization Review * Previous experience in ...
... Utilization Management department by performing clinical reviews forinpatient ... CurrentMA RN License, required * Bachelor's degree, required * 3-5 years nursing experience
... Utilization Management department by performing clinical reviews forinpatient ... CurrentMA RN License, required * Bachelor's degree, required * 3-5 years nursing experience
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Utilization Review Rn information
See Vernon, CT salary details
$21.38 - $25.71
2% of jobs
$25.71 - $30.03
9% of jobs
$32.99 is the 25th percentile. Wages below this are outliers.
$30.03 - $34.36
21% of jobs
The median wage is $37.86 / hr.
$34.36 - $38.68
23% of jobs
$38.68 - $43.01
13% of jobs
$46.37 is the 75th percentile. Wages above this are outliers.
$43.01 - $47.33
10% of jobs
$47.33 - $51.66
8% of jobs
$51.66 - $55.98
5% of jobs
$55.98 - $60.31
5% of jobs
$60.31 - $64.63
2% of jobs
$64.63 - $68.96
2% of jobs
$21
$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?
| Aspect | Utilization Review Rn | Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, certifications in case management |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, community agencies, insurance companies |
| Primary Focus | Reviewing medical necessity and appropriateness of care | Coordinating 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:
Full-time
Posted 6 days ago
Trinity Health rating
6.5
Based on 349 frontline employees who took The Breakroom Quiz
592nd of 872 rated healthcare providers
Job description
Employment Type:Full timeShift:Day ShiftDescription:
Position Summary
The Nurse Manager - Care Coordination & Utilization Management provides strategic and operational leadership for inpatient care coordination, case management, and utilization management services. This role partners with physicians, hospital leadership, and system stakeholders to ensure highquality, costeffective, patientcentered care while optimizing throughput, length of stay, and regulatory compliance.
Key Responsibilities
- Lead Care Coordination, Case Management, and Utilization Management teams, including staff development, performance management, and engagement
- Promote evidencebased nursing practice, patient safety, and interdisciplinary collaboration
- Oversee utilization management processes, levelofcare determinations, concurrent reviews, denials management, and appeals
- Collaborate with Physician Advisors, Finance, Revenue Integrity, Patient Access, and Compliance teams
- Monitor CMS and payer compliance (IMM/MOON, authorizations, documentation standards)
- Drive patient flow initiatives to support timely admissions, transitions of care, and discharge planning
- Analyze data, trends, and outcomes to support quality improvement and financial stewardship
- Participate in hospital and systemwide committees and strategic initiatives
- Support effective use of EPIC (TogetherCare) and reporting tools
Required Qualifications
- Active Registered Nurse (RN) license in Connecticut
- BSN required; MSN or Master's in related field preferred
- Minimum 5 years of healthcare experience, including leadership or management
- Experience in care coordination, case management, utilization management, or patient flow
- Strong communication, analytical, and changeleadership skills
Preferred Qualifications
- Master's degree (MSN or related healthcare field)
- Experience in utilization management, denial management, and payer relations
- Prior leadership experience in a large health system or multidepartment environment
- Knowledge of CMS regulations, payer requirements, and care management best practices
Why Join Trinity Health of New England?
- At Trinity Health of New England, we are committed to health and healing through excellence, compassionate care, and reverence for every person. Our leaders live our mission and values every day-Reverence, Commitment to Those Experiencing Poverty, Safety, Justice, Stewardship, and Integrity-while advancing care that makes a meaningful difference for our patients, families, and communities.
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
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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