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

Community Residences Inc

RN

Newington, CT · On-site

On a regular basis, reviews the following: * scheduled appointments for clients * relevant ... utilization of emergency services at the local and state levels. * Functions as the healthcare ...

Community Residences, Inc.

RN

Southington, CT · On-site

On a regular basis, reviews the following: * scheduled appointments for clients * relevant ... utilization of emergency services at the local and state levels. * Functions as the healthcare ...

Trinityhealth

Registered Nurse - RN - MSICU

Hartford, CT · On-site

$36.15 - $59.95/hr

Attend to patients requiring advanced monitoring, heightened observation, utilization of invasive ... Valid RN license in Connecticut * Candidates with a minimum of one year of acute inpatient nursing ...

Trinityhealth

Registered Nurse - RN - MSICU

Hartford, CT

$36.15 - $59.95/hr

Attend to patients requiring advanced monitoring, heightened observation, utilization of invasive ... Valid RN license in Connecticut * Candidates with a minimum of one year of acute inpatient nursing ...

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

Utilization Review Rn information

See Vernon, CT salary details

$21

$42

$68

How much do utilization review rn jobs pay per hour?

As of Aug 7, 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.

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.

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 knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

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.

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 August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,902 per year, or $42.3 per hour.

Clinical Resource Management RN in Hartford, CT

Vivian Health

Hartford, CT • On-site

Other

Posted 3 days ago

New

Job description

Clinical Resource Mgmt Nurse / Clinical Resource Management

Location Detail: 1290 Silas Deane Hwy Wethrsfld (10181)

Shift Detail: M-F 8:00am to 4:30pm with alternating weekends and holidays

Work where every moment matters. 
Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. 
The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.


With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.


Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment.
Position Summary:
 

The Clinical Resource Management Nurse is an integral part of the Care Management team whose focus is on performing a timely level of care assessment ideally at the immediate point of entry into the health system to ensure that patients are assigned the most appropriate patient class based on their clinical needs incorporating the judgment of their provider. The Clinical Resource Management Nurse is able to work autonomously and swiftly, managing a high volume of complex cases across all HHC system hospitals.
 


Position Responsibilities:

  1. Apply standard criteria and guidelines to assist in determining and/or to validate the patient class assigned by the provider.
  2. Document review and findings as well as any additional information relevant to the case as directed and appropriate.
  3. Partner with the Emergency Department and/or the Admitting Provider to ensure the patient class assigned is appropriate given the patient’s clinical presentation.
  4. Act as a resource and subject matter expert to the Emergency Department and/or the Admitting Provider on aspects of patient class and level of care determination.
  5. Escalate cases to designated Physician Advisor resource when assigned level of care is not appropriate and Emergency Department or Admitting Provider is unwilling to consider recommendations for alternative.
  6. Maintain knowledge of industry standards and regulatory requirements which influence patient class and level of care determinations.
  7. Provide education sessions to constituency groups as needs are identified and/or as requested.
  8. Support needs of the department in the event of a critical demand or a decrease in volumes by performing a review of work ques, crafting appeal responses, etc.
  9. Ensure any information critical to the care and progression of the patient gleaned during the review process is relayed to the Care Manager responsible for the patient.
  10. Complete assignments to demonstrate expert knowledge of criteria as requested.
  11. Other duties as assigned.

Qualifications
Education: Registered Nurse is required. BSN in Nursing is preferred
Experience: At least five (5) years of relevant clinical experience. Acute care or managed care utilization review is preferred. 
Licensure, Certification, Registration: Current State of Connecticut RN license
Knowledge, Skills and Ability Requirements:
  • Familiarity with clinical care
  • Able to influence and negotiate
  • Critical thinking, astute assessment and confident in decision making
  • Strong interpersonal and communication skills
  • Knowledge of Interqual or equivalent criteria and reimbursement guidelines
We take great care of careers.
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

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