Top 59 Utilization review Jobs in Hartford, Ct

Clinical Resource Mgmt Nurse / Clinical Resource Management
Hartford HealthCare Corp. —Wethersfield, CT
- Weekends as needed
- Nursing
- RN License
- Hospital
Quick Apply
Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite
Connecticut Children's Medical Center —Hartford, CT
- Nursing
- RN License
- Bachelor of Science
Care Management Assistant- 40hrs
Connecticut Children's Medical Center —Hartford, CT
- Full-time
- Microsoft Word
- 5 years
- Mid-level
Behavioral Health Senior Investigator (BCBA), Special Investigations Unit (Aetna SIU)
CVS Health —Hartford, CT
- $46,988 - $112,200 a year
- Full-time
- Mid-level
- Analysis skills
- Travel
- Health insurance
- Dental insurance
1d
Center for Care Coordination-Team Lead Utilization Review Nurse- Full Time
Connecticut Children's Medical Center —Hartford, CT
- Full-time
- Nursing
- RN License
- Bachelor of Science
Community Support Specialist
Rushford —Meriden, CT
- Full-time
- HIPAA
- Mid-level
- Residential
- Paid holidays
- Health insurance
Quick Apply
Case Manager
Waterbury Hospital —Waterbury, CT
- Full-time
- Nursing
- RN License
- Hospital
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Farmington, CT
- $2,922 a week
- Urgently hiring
- RN License
- BLS Certification
- Mid-level
- Travel reimbursement
- Health insurance
Quick Apply
5d
Clinical Case Manager
Waterbury Hospital —Waterbury, CT
- Part-time
- Nursing
- RN License
- Hospital
Medical Social Worker, Case Management
Trinity Health Of New England —Hartford, CT
- Full-time
- Master of Social Work
- Licensed Clinical Social Worker
- Inpatient
- Benefits from day one
RN Discharge Planner
Glastonbury Center for Health & Rehabilitation —Glastonbury, CT
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Retirement plan
OASIS Workflow Coordinator
Hartford HealthCare at Home —Mansfield Center, CT
- Full-time
- Nursing
- RN License
- Physical & Rehabilitation Medicine
Quick Apply
7d
Patient Access Associate III - Central Financial Clearance - 40hrs
Connecticut Children's Medical Center —Hartford, CT
- Full-time
- Microsoft Word
- HIPAA
- Mid-level
Patient Accounts - Assistant Manager Central Billing Office - 40hrs
Connecticut Children's Medical Center —Hartford, CT
- Full-time
- Writing skills
- Mid-level
- Office
Behavioral Health FSC LCSW- Per Diem
Connecticut Children's Medical Center —Hartford, CT
- Per diem
- Computer literacy
- Writing skills
- Licensed Clinical Social Worker
12d
Registered Nurse Emergency Department Case Manager RN
Trinity Health Of New England —Hartford, CT
- 12 hour shift
- Acute care
- Nursing
- RN License
Quick Apply
Supervisor, Intensive Family Preservation *$1,000 SIGN ON BONUS*
Klingberg Comprehensive Program Services Inc —New Britain, CT
- $62,000 - $72,000 a year
- Full-time
- Spanish
- Mid-level
- Master's degree
Quick Apply
Behavioral Health FSC (LCSW)- 40hr
Connecticut Children's Medical Center —Hartford, CT
- Full-time
- Computer literacy
- Writing skills
- Licensed Clinical Social Worker
Discharge Planner - Social Worker
Trinity Health Of New England —Enfield, CT
- Part-time
- Master of Social Work
- Hospital
- Inpatient
RN Case Coordinator
Hartford Hospital —Hartford, CT
- Full-time
- Nursing
- RN License
- Inpatient
Quick Apply

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utilization review jobs near hartford, ct

Clinical Resource Mgmt Nurse / Clinical Resource Management

Hartford HealthCare Corp. -
Wethersfield, CT

Quick Apply

Job Details

Full-time

Qualifications

RN License
Healthcare reimbursement methods
Negotiation

Full Job Description

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:

Apply standard criteria and guidelines to assist in determining and/or to validate the patient class assigned by the provider.
Document review and findings as well as any additional information relevant to the case as directed and appropriate.
Partner with the Emergency Department and/or the Admitting Provider to ensure the patient class assigned is appropriate given the patient’s clinical presentation.
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.
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.
Maintain knowledge of industry standards and regulatory requirements which influence patient class and level of care determinations.
Provide education sessions to constituency groups as needs are identified and/or as requested.
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.
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.
Complete assignments to demonstrate expert knowledge of criteria as requested.
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.

Quick Apply

Refine Your Search

utilization review jobs in hartford, ct

Clinical Resource Mgmt Nurse / Clinical Resource Management

Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite

Care Management Assistant- 40hrs

Behavioral Health Senior Investigator (BCBA), Special Investigations Unit (Aetna SIU)

Center for Care Coordination-Team Lead Utilization Review Nurse- Full Time

Community Support Specialist

Case Manager

Travel RN - Case Management/Utilization Review - Case Management

Clinical Case Manager

Medical Social Worker, Case Management

RN Discharge Planner

OASIS Workflow Coordinator

Patient Access Associate III - Central Financial Clearance - 40hrs

Patient Accounts - Assistant Manager Central Billing Office - 40hrs

Behavioral Health FSC LCSW- Per Diem

Registered Nurse Emergency Department Case Manager RN

Supervisor, Intensive Family Preservation $1,000 SIGN ON BONUS

Behavioral Health FSC (LCSW)- 40hr

Discharge Planner - Social Worker

RN Case Coordinator

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