Talent.com
SolutionHealth
Utilization Review RN- Care Coordination- Full TimeSolutionHealth • Manchester, Connecticut, USA
Utilization Review RN- Care Coordination- Full Time

Utilization Review RN- Care Coordination- Full Time

SolutionHealth • Manchester, Connecticut, USA
6 days ago
Job type
  • Full-time
  • Part-time
Job description

Come work at the best place to give and receive care!

Job Description:

RN Utilization Review

Who We Are:

Elliot Health Systems Care Coordination Department located in Manchester NH plays a vital role in ensuring seamless patient-centered care across the healthcare continuum. Our team is dedicated to care management discharge planning and patient advocacy working closely with providers social workers and community resources to enhance patient outcomes. By developing individualized care plans facilitating smooth transitions between care settings and offering proactive support we help patients navigate complex healthcare needs while improving overall access to high-quality coordinated care.

About the Job:

Under the direction of the Director of Care Coordination the Utilization Review RN (UR RN) is responsible for ensuring the effective and efficient use of hospital services in alignment with the hospitals utilization review plan.

What Youll Do:

  • Complete admission reviews to determine the appropriate level of care.
  • Document continued stay reviews to assess the necessity of inpatient care procedures and estimated length of stay.
  • Communicate and collaborate with payer care managers to prevent denials by ensuring timely clinical reviews.
  • Address potential denials proactively working with physicians and payer representatives to minimize retrospective denials.
  • Screen all patients upon admission or the next business day to determine appropriate level of care using medical necessity tools Medicare Inpatient Only List and payer requirements.
  • Monitor observation status patients to ensure appropriate utilization and collaborate with admitting physicians if documentation does not support the current level of care.
  • Perform concurrent reviews to justify extended stays working with attending physicians to ensure accurate documentation of medical necessity.
  • Refer cases that do not meet admission or continued stay guidelines to the Utilization Review Physician Advisor after discussions with attending physicians.

Who You Are:

  • Graduate of an accredited nursing program (Bachelors degree in Nursing required for nurses hired after May 2015 or commitment to obtain within a specified timeframe).
  • Minimum of three (3) years of experience in hospital case management or utilization management.
  • Active New Hampshire or Compact State RN license required.
  • CCM or ACM certification preferred.

Why Youll Love Us:

  • Health dental prescription and vision coverage for full-time & part-time employees
  • Short-term long-term disability life & pet insurance
  • Tuition reimbursement
  • 403(b) Retirement savings plans
  • Continuous earned time accrual

Work Shift:

8:00-4:30

SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation disability status veteran status or any other characteristic protected by law.


Employment Type : Full-Time
Experience: years
Vacancy: 1
Create a job alert for this search

Utilization Review RN- Care Coordination- Full Time • Manchester, Connecticut, USA

Similar jobs

Critical Care Float Nurse / Float RN (ICU)

Yale New Haven HealthHartford, Connecticut, US
Full-time

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values.These values - integrity, patient-centered, respect, account... Show more

 • Promoted

Quality Improvement Coordinator

Athena Health Care SystemsAgawam, MA, United States
Full-time

We are hiring an RN QAPI Coordinator to join our dynamic care team at Hospice of Western & Central Massachusetts!32 hours a week with weekly pay ranging from $45 to $48 an hour.Works out of our... Show more

 • Promoted

RN ED Observation Unit

Hartford HospitalHartford, CT, United States
Full-time

Location Detail:80 Seymour Street (10008)Work where every moment matters.Every day, over than 40,000 Hartford HealthCare colleagues come to work with one thing in common:Pride in what we do, knowin... Show more

 • Promoted

Travel Nurse RN - Utilization Review - $2,989 to $3,084 per week in Everett, MA

TravelNurseSourceSpringfield, Massachusetts, US
$2,989.00 weekly
Full-time

Registered Nurse (RN) | Utilization Review.TravelNurseSource is working with GQR Healthcare to find a qualified Utilization Review RN in Everett, Massachusetts, 02149!.Contract - W2 Case Management... Show more

 • Promoted

Connecticut Facility Needs a Locum Tenens CRNA

Weatherby HealthcareHartford, CT, United States
Full-time

Enjoy the locum tenens lifestyle knowing Weatherby is here to support you every step of the way.Call and speak to one of our consultants today for available dates and details.Mon-Fri 8, 10, 12, or ... Show more

 • Promoted

Patient Coordinator

Aspen DentalGlastonbury, CT, United States
Full-time

At Aspen Dental, we put You first, offering the security and job stability that comes with working with a world-class dental service organization (DSO).Our best-in-class training program, competiti... Show more

 • Promoted

Senior Patient Care Coordinator

UnitedHealth GroupManchester, CT, United States
Full-time

Requisition number:** 2375158 **Job category:** Healthcare Delivery, Patient Services **Opportunities with ProHealth Physicians** , part of the Optum family of businesses.When you work at ProHe... Show more

 • Promoted

CRNA Needed for Locum Tenens Coverage in Connecticut

LocumTenens.comRocky Hill, Connecticut, United States
Full-time

Job Reference Id: ORD-217717-CRNA-CT.Board Certification Required: Negotiable.Hospital looking for CRNA Coverage.Connecticut offers a range of regional attractions and recreational opportunities su... Show more

 • Promoted

CRNA Locum- Locums/Travel

Medicus Healthcare SolutionsAgawam, MA, United States
Full-time

Multiple facilities in central Massachusetts have openings for a skilled CRNA to assist their teams.Flexible Schedule:12, 16, 18, and 24-hour shifts available No call shifts required Shifts availab... Show more

 • Promoted

Travel Nurse RN - Endoscopy - $2,008 to $2,226 per week in Wallingford, CT

TravelNurseSourceWallingford, CT, US
$2,008.00 weekly
Full-time

Registered Nurse (RN) | Endoscopy.TravelNurseSource is working with LRS Healthcare to find a qualified Endoscopy RN in Wallingford, Connecticut, 06492!.Ready to start your next travel adventure? LR... Show more

 • Promoted

Registered Nurse

DaVita Inc.Branford, CT, United States
Full-time

Posting Date 07/07/2026 249 West Main St, Branford, Connecticut, 064054022, United States of America Make a real impact-every day.As a DaVita RN, you'll ensure compassionate and professional del... Show more

 • Promoted

CRNA Needed for Locum Tenens Coverage at Operating Room in Connecticut

LocumTenens.comRocky Hill, Connecticut, United States
Full-time

Job Reference Id:  ORD-210079-CRNA-CT.Dates Needed:  Immediate start, ongoing coverage.Board Certification Required:  Negotiable.The facility operates a comprehensive surgical department requiring ... Show more

 • Promoted

Registered Nurse RN Inpatient Care Coordinator

Trinity HealthSpringfield, MA, United States
Full-time

RN Inpatient Care CoordinatorAt Mercy Medical Center our RN Inpatient Care Coordinators are responsible for coordinating patient care, assessing needs, and developing care plans.They collaborate wi... Show more

 • Promoted

Remote Outpatient Utilization Review Nurse (RN)

Baystate HealthSpringfield, MA, United States
Remote
Full-time

A not-for-profit health plan provider is seeking a UM Outpatient Clinical Review Nurse for a full-time remote position.This role requires a current Massachusetts RN license and involves conducting ... Show more

 • Promoted

Patient Care Coordinator I

Boston Orthotics and ProstheticsGuilford, CT, United States
Full-time

OrthoPediatrics Specialty BracingAs a leader in specialized pediatric orthotics, we take great pride in having the industry's top clinicians, technicians, and administrative staff, led by an execut... Show more

 • Promoted

Outpatient Registered Nurse - RN

Fresenius Medical CareSpringfield, MA, United States
Full-time

PURPOSE AND SCOPE: The professional registered nurse Outpatient RN CAP 1 is an entry level designation into the Clinical Advancement Program (CAP).This position is accountable and responsible for ... Show more

 • Promoted

Locums Opportunity in CT for CRNA

Weatherby HealthcareHartford, CT, United States
Full-time

Interested? Give Weatherby a call today and speak with one of our specialty-specific consultants for available dates and details.Mon-Fri 8s, 10s, 12s or possibly 16s, Sat and Sun 10 hour shifts Age... Show more

 • Promoted

Travel Operating Room RN - $2,707 per week

HumanEdge Travel HealthcareHartford, CT, United States
Full-time

HumanEdge Travel Healthcare is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Hartford, Connecticut.Job Description & Requirements Specialty:OR - Operating Room Disci... Show more

 • Promoted

Registered Nurse - ICU - Relocation to Glens Falls, NY

Glens Falls HospitalMadison, Connecticut
$37.00 hourly
Full-time
Quick Apply

Patient care never stops, and our night team is vital to our success.This role includes shared coverage for overnight shifts.We utilize a collaborative scheduling system to ensure shift distributio... Show more

 • Promoted

Home Health- Registered Nurse- New Pay Rates- Sign-On Bonus (Branford Area)

Yale-New Haven HealthBranford, CT, United States
Full-time

Overview Yale New Haven Health-Health at Home has amazing opportunities available for full-time Home Health RNs-Registered Nurses in Home-health for our Guilford and Branford offices.Benefits of a... Show more