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

Qualifications

  • 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

Apply

Explore your Recruiting Career

Discover the wide range of opportunities Green Key has to offer.

Learn More

Join Our Network

You’ve worked hard for your industry experience. Now put that experience to work.

Send us your resume

Green Key Blog

News for the way you work.

More from the blog