Available Positions

Utilization Management Nurse at Health Insurance Company in Fairfield, Connecticut, United States —

  • Healthcare
  • Health Insurance Company
  • Fairfield, Connecticut, United States
  • 7/6/20

Job ID: 1030200

Job Description

  • Insurance company in Fairfield County looking for a full-time RN Utilization Manager to join their team as soon as possible
  • Full time case load: Monday – Friday, 10-15 caseload per week to start
  • Responsibilities will include:
    • Act as the clinical coordinator collaborating with members, caregivers, providers, TPH multi-disciplinary team, and health care and community resources to evaluate member needs through a variety of assessments
    • Provide individual performance summaries and data for review with individuals
    • Maintain monthly tracking and reporting system for quality and productivity components
    • Investigate trends, identify problems, and work collaboratively with specific individuals to resolve issues
    • Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards
    • Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA
    • Collaborate with department manager in hiring, staff development, evaluations, and training to ensure cohesive department
    • Identify and analyze current workflow and procedures to recommend process improvements, system enhancements, and benefit changes


  • 3+ years nursing experience
  • CT RN license
  • Utilization management or care management certification preferred
  • Case Management experience in long term care, hospital, or managed care
  • Electronic medical record knowledge preferred


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