Utilization Management Director jobs in New Haven, CT

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Sr. Inpatient Utilization Management Nurse. 

 Primary Responsibilities: 

• Perform Utilization Review of admissions and/or continuing inpatient stay by utilizing standardized clinical criteria as well as the DSS contractual definition of Medical Necessity.
• Discuss clinical reviews with Medical Reviewers as needed.

 Tasks Performed: 

• Presents summarized information to medical reviewers when second level review is necessary. 
• Makes referrals to intensive case management and the behavioral health ASO when appropriate. 
• Identifies and refers quality of care issues as part of admission and continued stay reviews. 
• Acts as preceptor to new staff. 
• May be asked to support other areas of the UM department including performing first level medical necessity reviews for elective inpatient admissions and outpatient services.
• Performs other duties as assigned.

 Essential Functions: 

• Conducts clinical review for members receiving care in an inpatient setting. 
• Requires the ability to efficiently filter through large amounts of clinical data, to obtain pertinent information based on condition and presentation, applying clinical guidelines to facilitate appropriate decision making without compromising accuracy. 
• Reviews the appropriateness and medical necessity of admissions utilizing InterQual criteria. 
• Makes first level approval determinations and appropriately refers cases to Medical Director for second level review when case does not meet InterQual criteria.

Desired Education: Two to four years post-secondary schooling

Desired Degree: Bachelor's degree preferred

Desired Major: Nursing (required)

Desired Job Experience: Three to five years' related experience with at least three years of clinical experience. Managed care experience preferred.

Certifications Required: Active Registered Nurse License

Hiring Salary Range: $80,500.00 - $90,000.00 

CHNCT Offers Great Benefits:

• Medical, dental and vision coverage options
• Flexible spending and health savings accounts
• Group term life insurance
• A 401(k) plan with company-match and immediate vesting
• Voluntary accidental injury coverage
• Tuition reimbursement and continuing education opportunities
• A generous paid-leave bank and company holidays
• Wellness program

CHNCT is an equal opportunity, affirmative action employer m/f/d/v and proud of the diversity of our workforce. 

Important Note to Applicants:  CHNCT as a company feels very strongly that we need to do what we can to help control the spread of COVID-19 infections. Therefore, all employees, contractors, consultants and agency temporary staff are required to be fully vaccinated to work at CHNCT. Reasonable accommodations for medical or religious exemptions will be provided with appropriate documentation for positions that do not have in-person/member visitation requirements.