Utilization Management RN (Hybrid) – Drive Optimal, Cost-Efficient Care

Trinity Health Of New England; Hartford (CT); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Hybrid work schedule

Job summary

Saint Francis Hospital in Connecticut is seeking a Utilization Management (UM) Registered Nurse to review medical services and treatment plans for cost-effective, high-quality patient care.

You will collaborate with physicians, care teams, and payers to support appropriate resource use, timely discharge planning, and compliance with InterQual/Milliman criteria. CT RN license required; BSN preferred; 3+ years UM/UR experience in acute care; hybrid work schedule.

Qualifications

• Graduate of an accredited School of Nursing.
• Current, unrestricted Connecticut RN license.
• BSN preferred.
• Three or more years of Utilization Management/Utilization Review/Case Management or related experience in an acute care hospital setting.
• Experience utilizing InterQual and/or Milliman clinical criteria.

Responsibilities

• Conduct concurrent utilization reviews to determine appropriate level of care using established criteria.
• Initiate, manage, and track admission authorizations and payer communications.
• Review insurance denials and support appeals processes.
• Collaborate with physicians, case managers, and care teams to optimize care plans and discharge planning.
• Ensure documentation reflects severity of illness, medical necessity, and resource utilization.
• Partner with Finance, HIM, Admitting, and other departments to support UM activities.
• Work with care coordination teams to promote high-quality, patient-centered outcomes.
• Maintain compliance with regulatory, accreditation, and payer requirements.

Skills

Clinical skills

Collaboration

Education

Bachelor of Science in Nursing

Connecticut RN license

Tools

InterQual criteria

Milliman criteria

Job description

Saint Francis Hospital in Connecticut is seeking a Utilization Management (UM) Registered Nurse to review medical services and treatment plans for cost-effective, high-quality patient care.

You will collaborate with physicians, care teams, and payers to support appropriate resource use, timely discharge planning, and compliance with InterQual/Milliman criteria. CT RN license required; BSN preferred; 3+ years UM/UR experience in acute care; hybrid work schedule.