Top 21 Utilization review nurse Jobs in Waterbury, Ct

Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite
Connecticut Children's Medical Center —Hartford, CT
- Nursing
- RN License
- Bachelor of Science
Utilization Management Registered Nurse RN
Trinity Health Of New England —Hartford, CT
- Full-time
- Hybrid work
- Nursing
- RN License
- Bachelor of Science
4d
Case Manager - FT Days | Waterbury Rehab
PAM Health, LLC —Waterbury, CT
- Full-time
- RN License
- Hospital
- BLS Certification
- Health savings account
- Disability insurance
Quick Apply
3d
Clinical Case Manager
Waterbury Hospital —Waterbury, CT
- Part-time
- Nursing
- RN License
- Hospital
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
RN Case Coordinator
Hartford Hospital —Hartford, CT
- Full-time
- Nursing
- RN License
- Inpatient
Quick Apply
Care Coordinator (RN) - Social Work
MidState Medical Center —Meriden, CT
- Full-time
- Acute care
- Nursing
- RN License
Quick Apply
Case Management Coordinator Per Diem
Griffin Hospital —Derby, CT
- Per diem
- Nursing
- RN License
- Mid-level
Quick Apply
4d
RN Clinical Case Manager
University of Connecticut —Farmington, CT
- Full-time
- Nursing
- RN License
- Inpatient
12d
Travel RN - Case Management/Utilization Review - Case Management
American Traveler —Farmington, CT
- $2,922 a week
- Contract
- RN License
- BLS Certification
- Mid-level
- Travel reimbursement
- Health insurance
Quick Apply
10d
Clinical Resource Mgmt Nurse / Clinical Resource Management
Hartford HealthCare Corp. —Wethersfield, CT
- Weekends as needed
- Nursing
- RN License
- 5 years
Quick Apply
Home Care RN Clinical Manager
Optum —Rocky Hill, CT
- $59,664 - $89,496 a year
- Full-time
- Nursing
- RN License
- Pass drug screening
Quick Apply
4d
MDS Coordinator Experienced!!!
Meriden Health & Rehab —Meriden, CT
- Full-time
- Anatomy knowledge
- Skilled nursing facility
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
RN Supervisor, 3-11 shift, Monday-Friday
Waterbury Center for Nursing and Rehabilitation —Waterbury, CT
- $50 - $55 an hour
- Full-time
- Nursing
- Anatomy knowledge
- Blood sampling
Quick Apply
7d
Advanced Practice Registered Nurse - Part-Time
Boca Recovery Center —Hartford, CT
- Part-time
- CPR Certification
- Nursing
- Psychiatry
- Disability insurance
- Health insurance
Quick Apply

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Denial and Appeals RN / Clinical Resource Management
Hartford HealthCare Corp. —Wethersfield, CT
CCM (certified case manager), CPUM (certified professional in utilization management), or other relevant certification is preferred.
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Hospice Weekend RN (Registered Nurse, Visiting Nurse) SIGN ON BONUS - HomeCare
Hartford HealthCare at Home —Southington, CT
Makes follow-up visits to provide skilled care to assess disease progress and evaluates response to treatment so as to promote peaceful death; provides support…
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Case Manager (RN) - Full-Time
OhioHealth Rehabilitation Hospital —Columbus, OH
Current Licensure per state guidelines in clinical or related discipline OR a Bachelor's or Master's in a health or human services discipline.
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Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite

Connecticut Children's Medical Center -
Hartford, CT

Apply Now

Job Details

Qualifications

RN License
Task prioritization
Bachelor of Science in Nursing
Bachelor's degree in nursing
Negotiation

Full Job Description

Connecticut Children’s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children’s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.

At Connecticut Children’s, treating children isn’t just our job – it’s our passion. As a leading children’s health system experiencing steady growth, we’re excited to expand our team with exceptional team members who share our vision of transforming children’s health and well-being as one team.

Applicants must be residents of Connecticut, Massachusetts, or New York to be considered for this position.

The Center

Connecticut Children’s Center for Care Coordination (The Center) is dedicated to the integration of care coordination through the delivery of innovative programs, providing technical assistance, disseminating best practices, and building inclusive partnerships to strengthen families and build stronger communities. The Center utilizes a universal, evidence based, research informed, and policy driven approach to enhanced care coordination that not only meets the interrelated medical, developmental, behavioral, and social needs of children, but enhances the care giving capacity of families. This team reports to The Center for their leadership.

Position Details

The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity determinations. The candidate should possess a working knowledge of medical necessity tools such as InterQual® and Milliman Care Guidelines® and be proficient in medical record reviews. This individual supports the Care Management program by developing and/or maintaining effective and efficient processes for determining the defensible hospitalization status based on regulatory and reimbursement requirements of various commercial and government payers. The purpose of the POE is to support the physician and other qualified practitioners in determination of defensible patient class at the time of admission in the ED. The POE serves as a resource to all members of the health care team on defensible patient status and promotes effective utilization of hospital resources.

This individual maintains current and accurate knowledge regarding commercial and government payers including regulatory requirements. The POE nurse will function in accordance with facility policies and processes. This individual will support process improvement activities and report key metrics to facility leadership as requested. audiences. The POE Nurse effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment. The POE Nurse participates and provides support to the hospital’s Utilization Management Committee. They collaborate with multiple leaders at various levels throughout the organization. This is an on-site role interfacing with the admitting physician on cases to support industry-accepted level of care criteria.

Performs chart review of assigned patients to identify quality, timeliness, and appropriateness of patient care. Conducts hospitalization reviews based on appropriate guidelines. Uses these criteria to screen for defensible level of care based on medical record documentation. Escalates cases as appropriate for secondary review. -15%
Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals for secondary review. Identifies, develops, and implements strategies to reduce length of stay and resource consumption in conjunction with discharge planning staff. -15%
Provides consultation and education to physicians and other qualified practitioners regarding medical record documentation necessary to support the ordered level of care. -10%
Performs and documents initial / admission medical necessity review for all points of entry. -10%
Communicates initial medical necessity review results with emergency department and admitting providers as necessary to support defensible admission status orders. -10%
Proactively collaborates with emergency department providers and staff to identify patients likely to require hospitalization. -10%
Works in conjunction with emergency department social workers and other staff to identify and secure available and necessary services to support clinically appropriate hospital admission avoidance. -3.0%
Obtains information from patient, caregivers, providers of services, insurance company, benefits administrators and others as necessary. - .5%
Conveys benefit data and options, programs and other forms of assistance that may be available to the patient, and negotiates for services as indicated. -.5%
Communicates pertinent reimbursement information to healthcare team while observing patient right to confidentiality. -.5%
Verifies in-network verses out-of-network benefits and communicates data to the patient and healthcare team as indicated. -.5%
Pre-Admission Reviews -15%
- Performs prospective medical record review of patients scheduled for outpatient/inpatient procedures scheduled in the hospital setting.
- Works in collaboration with Finance to identify the appropriate setting for scheduled admissions, procedures, and medication administration by reviewing pertinent clinical information and collaborating to obtain prior authorization when necessary.
- Screens scheduled patients to ensure that they are scheduled in a defensible utilizing industry-accepted level of care criteria.

Additional Responsibilities -5%

Collaborates with other members of The Center team to coordinate the right care, in the right setting, at the right time for CT Children’s patients.
Assist with discharge planning as necessary to coordinate the right care, in the right setting and the right time for CT Children’s patients.
Identify gaps in care/resources and address issues that negatively impact access to care, services, and resources
Function as a change agent, advocate, and resource person for family and healthcare team to identify and resolve performance improvement issues within the system.
Commitment to ONE TEAM Culture. -2.5%
Performs other job-related duties as assigned. -2.5%

Education and/or Experience Required:

Education: Bachelor of Science in Nursing (BSN)
Experience: 3 years of nursing experience in a healthcare setting

Education and/or Experience Preferred:

Experience:
- Pediatric nursing experience
- Previous experience in Utilization Review
- Previous experience in Case Management or Discharge planning

License and/or Certification Required:

State if Connecticut Nursing License.

License and/or Certification Preferred:

Case Management Certification.

Knowledge, Skills and Abilities:

Knowledge:

Demonstrate working knowledge of how to interpret and apply medical care criteria.
Knowledge of community resources, treatment options, home health availability, funding options and special programs.

Skills:

Coordinates management of care for a specified patient population; follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with hospital standards
Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs.
Skilled in the operation of the computer including proficiency in Microsoft Office Word, ability to use/update Excel spreadsheets and ability to navigate EPIC.

Abilities:

Self-directed/motivated, organized, diplomatic and team-oriented.
Function in a high energy, fast moving environment.
Maintain flexibility as determined by acuity of medical unit.
Prioritize case load.
Collaborate with various disciplines.
Communicate effectively and efficiently.
Prioritize and manage multiple tasks.
Excellent written and verbal communication skills.

Apply Now

Refine Your Search

utilization review nurse jobs in waterbury, ct

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

Utilization Management Registered Nurse RN

Case Manager - FT Days | Waterbury Rehab

Clinical Case Manager

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

RN Case Coordinator

Care Coordinator (RN) - Social Work

Case Management Coordinator Per Diem

RN Clinical Case Manager

Travel RN - Case Management/Utilization Review - Case Management

Clinical Resource Mgmt Nurse / Clinical Resource Management

Home Care RN Clinical Manager

MDS Coordinator Experienced!!!

RN Supervisor, 3-11 shift, Monday-Friday

Advanced Practice Registered Nurse - Part-Time

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