Utilization Management RN — Drive Quality & Cost-Efficiency

IHA; Hartford (CT); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Saint Francis Hospital in Connecticut seeks a Utilization Management Registered Nurse to review services and treatment plans for quality and cost effectiveness. You will collaborate with providers, care teams, and patients to optimize outcomes while ensuring appropriate resource use.

Responsibilities include concurrent reviews, authorizations, appeals support, and accurate clinical documentation. A CT RN license is required; BSN is preferred.

Qualifications

• Graduate of an accredited School of Nursing.
• Current, unrestricted Connecticut RN license.
• BSN preferred; 3+ yearsUtilization Management or related experience; knowledge of InterQual/Milliman criteria.

Responsibilities

• Conduct concurrent utilization reviews using established criteria.
• Initiate, manage, and track admission authorizations and payer communications.
• Review denials, support appeals, and identify UM process improvements.
• Collaborate with physicians and care teams to optimize care plans and discharge planning.
• Ensure documentation reflects severity of illness and medical necessity.
• Partner with departments to support UM activities and organizational goals.
• Work with care coordination teams to promote high-quality, cost-effective outcomes.
• Maintain compliance with regulatory, accreditation, and payer requirements.

Skills

Clinical judgement

Collaboration

Documentation accuracy

Education

Connecticut RN license

Tools

InterQual criteria

Milliman criteria

Job description

Saint Francis Hospital in Connecticut seeks a Utilization Management Registered Nurse to review services and treatment plans for quality and cost effectiveness. You will collaborate with providers, care teams, and patients to optimize outcomes while ensuring appropriate resource use.

Responsibilities include concurrent reviews, authorizations, appeals support, and accurate clinical documentation. A CT RN license is required; BSN is preferred.