Utilization Management Nurse
17 hours ago
We are seeking a highly skilled Utilization Management Nurse to join our team at Yale University. As a key member of our healthcare team, you will be responsible for optimizing the utilization of healthcare resources while ensuring high-quality patient care.
Key Responsibilities- Conduct thorough reviews of patient cases to assess the necessity and appropriateness of medical services and treatments.
- Evaluate clinical documentation to ensure compliance with established guidelines, medical necessity criteria, and payer requirements.
- Review and process authorization requests for medical procedures, diagnostic tests, and hospital admissions.
- Collaborate with healthcare providers and care management teams to gather additional information, clarify treatment plans, and address any discrepancies.
- Review precertification requests for medical necessity, utilizing MCG medical necessity criteria and clinical evidence assessing the treatments appropriateness, effectiveness, timing, and setting.
- Bachelor's Degree in Nursing and two years' experience or an equivalent combination of education and experience.
- Strong clinical assessment and critical thinking skills.
- Excellent communication and interpersonal skills.
- Capable of detailed understanding of the healthcare benefits package, identifying cases and situations in which clarification and timely decision making are needed.
- Master's Degree in Nursing or Healthcare Administration.
- Certification in Utilization Review (CPUR or equivalent).
Yale University offers a competitive salary and benefits package, as well as opportunities for professional growth and development.
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Clinical Utilization Analyst
4 weeks ago
New Haven, Connecticut, United States Saint Francis Health System Full timeCurrent Saint Francis Employees - Please click HERE to login and apply. Position Type: Full Time Shift: 11:00 PM - 7:00 AM Work Arrangement: Fully Onsite Job Overview: The Clinical Utilization Analyst will assess patient documentation to validate the necessity of hospital admissions, treatments, and the appropriate level of care required. This role will...
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Clinical Utilization Analyst
4 weeks ago
New Haven, Connecticut, United States Saint Francis Health System Full timeCurrent Saint Francis Employees - Please click HERE to login and apply. Position Type: Full Time Shift: 11:00 PM - 7:00 AM Work Arrangement: Fully Onsite Job Overview: The Clinical Utilization Analyst will evaluate patient documentation to assess the validity of hospital admissions, treatments, and the appropriate level of care required. This role will...
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Clinical Utilization Specialist
3 weeks ago
New Haven, Connecticut, United States Saint Francis Health System Full timeJob SummaryWe are seeking a skilled Clinical Utilization Specialist to join our team at Saint Francis Health System. As a key member of our Utilization Review Management team, you will play a critical role in ensuring the efficient and effective management of patient care.Key ResponsibilitiesMonitor admissions and perform initial patient reviews within 24...
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Nurse Manager
4 weeks ago
New Haven, Connecticut, United States Clinical Management Consultants Full timeJob Summary:Clinical Management Consultants is seeking a highly skilled and experienced Behavioral Health Nurse Manager to lead our team in Central Connecticut. As a Behavioral Health Nurse Manager, you will be responsible for overseeing the Geriatric and Adult Behavioral Health Units, demonstrating progressive leadership qualities to lead the unit staff to...
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Case Manager
24 hours ago
New Haven, Connecticut, United States Yale New Haven Health Full timeJob Title: Case ManagerAt Yale New Haven Health, we are seeking a skilled Case Manager to join our team. As a Case Manager, you will play a critical role in ensuring high-value patient care that is coordinated, efficient, and aligned with institutional clinical and financial objectives.Responsibilities:Coordinate and ensure the implementation of the plan of...
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Care Manager
9 hours ago
New Haven, Connecticut, United States Yale New Haven Health Full timeJob DescriptionAt Yale New Haven Health, we are seeking a highly skilled Care Manager to join our team. As a key member of our healthcare team, you will play a critical role in ensuring high-value patient care that is coordinated, efficient, and aligned with institutional clinical and financial objectives.ResponsibilitiesCoordinate and ensure the...
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Travel Nurse Position
2 hours ago
New Haven, Connecticut, United States Travel Nurse Source Full timeTravel Nursing Opportunity with Coast Medical ServiceWe are working with Coast Medical Service to find a qualified ER/Trauma RN for a travel nursing assignment in Meriden, Connecticut.About the PositionCoast Medical Service is a nationwide travel nursing & allied healthcare staffing agency dedicated to providing an elite traveler experience for experienced...
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Traveling Operating Room Nurse
4 days ago
New Haven, Connecticut, United States Travel Nurse Source Full timeAbout the PositionGet Med Staffing is seeking a skilled Operating Room Registered Nurse to join our team of travel nurses. This opportunity is perfect for a nurse looking to gain diverse experiences and expand their professional horizons.Job RequirementsMinimum of 1-2 years of experience in the Operating RoomCurrent ACLS and BLS/CPR certificationsCore...
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Healthcare Operations Manager
4 weeks ago
New Haven, Connecticut, United States New Haven BH Rescare Full timeJob Summary:New Haven BH Rescare is seeking a highly skilled and experienced Clinical Manager Registered Nurse to join our team. As a Clinical Manager, you will be responsible for the coordination of high-quality, cost-effective patient care and the operations of our agency.Key Responsibilities:Understand the criteria for acceptance of patients and...
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Travel Nurse RN Position
1 week ago
New Haven, Connecticut, United States Travel Nurse Source Full timeAbout the PositionWe are seeking a qualified Registered Nurse to join our team as a Travel Nurse in New Haven, Connecticut.Job DetailsPay Information: $1,899 per weekShift Details: 8H Days (7:00 AM-3:30 PM), 40 hours per weekLength: 13 WEEKSAbout the FacilityClinic New Haven is a reputable healthcare facility seeking a skilled Registered Nurse to join their...
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Travel Nurse RN Position
2 weeks ago
New Haven, Connecticut, United States Travel Nurse Source Full timeTravel Nursing OpportunityWe are working with Triage Staffing to find a qualified OR RN for a travel nursing position in Connecticut.Job DetailsPay Information: $2,754 per weekLocation: New BritainShift Details: 12H Days (12:00 AM-12:00 PM) 36 hours per weekLength: 13 weeksAbout the PositionTravel Nursing:The OR RN will work in a dynamic environment,...
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New Haven, Connecticut, United States Travel Nurse Source Full timeAbout the Position:We are seeking a skilled and dedicated OR Registered Nurse to join our team for a 13-week assignment in a reputable healthcare facility. As a travel nurse with Travel Nurse Source, you will have the opportunity to work in a dynamic and supportive environment, providing high-quality patient care and advancing your professional growth.Job...
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Travel Nurse RN Position
2 weeks ago
New Haven, Connecticut, United States Travel Nurse Source Full timeTravel Nursing OpportunityWe are working with Triage Staffing to find a qualified Med/Surg RN for a travel nursing assignment in Connecticut.Job DetailsPay Information: $2,168 per weekLocation: HartfordShift Details: 12H Days (12:00 AM-12:00 PM), 36 hours per weekLength: 13 weeksAbout the Position:As a Med/Surg RN, you will be responsible for providing...
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Travel Nurse RN Position
3 weeks ago
New Haven, Connecticut, United States Travel Nurse Source Full timeAbout the PositionTravel Nurse Source is working with Triage Staffing to find a qualified Operating Room Registered Nurse for a 13-week assignment in Connecticut.Pay Information$2,754 per weekAbout the AssignmentThis is a 12-hour day shift position, working 36 hours per week. The assignment will take place in a hospital setting, providing care to patients in...
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Nurse Practitioner
1 hour ago
New Haven, Connecticut, United States Saint Francis Health System Full timeJob Summary:The Registered Nurse I (PRN) is responsible for assessing, planning, implementing, and evaluating nursing care for patients in a medical/surgical float pool setting. This role requires a strong understanding of general disease state management processes, bio-psychosocial models, and clinical pathways.Key Responsibilities:Utilize the nursing...
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Nurse Manager
18 hours ago
New Haven, Connecticut, United States Yale New Haven Health Full timeJob SummaryWe are seeking a highly skilled and experienced Registered Nurse to join our team as a Nurse Manager. As a Nurse Manager, you will be responsible for leading a team of nurses and other healthcare professionals to provide high-quality patient care. You will be responsible for supervising and evaluating the work of nurses, developing and...
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Clinical Revenue Management Specialist I
4 weeks ago
New Haven, Connecticut, United States Yale New Haven Health Full timeJob SummaryWe are seeking a highly skilled Clinical Revenue Management Specialist to join our team at Yale New Haven Health. The successful candidate will be responsible for performing a wide range of clinical revenue management activities to prevent insurer denials, enhance revenue, and recover payment for services that have been denied.Key...
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Neuroscience Registered Nurse
2 weeks ago
New Haven, Connecticut, United States Saint Francis Health System Full timeJob SummaryThe Clinical Nurse I is responsible for assessing, planning, implementing, and evaluating nursing care for patients in the Neuroscience unit. This role requires a strong understanding of general disease state management processes, bio-psychosocial models, and clinical pathways.Key ResponsibilitiesUtilize the nursing process to care for patients,...
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Registered Nurse I
13 hours ago
New Haven, Connecticut, United States Saint Francis Health System Full timeJob SummaryThe Registered Nurse I is responsible for assessing, planning, implementing, and evaluating nursing care for patients in the Inpatient Rehabilitation Unit. This role requires a strong understanding of general disease state management processes, bio-psychosocial models, and clinical pathways.Key ResponsibilitiesUtilize the nursing process to care...
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Neuroscience Registered Nurse
1 week ago
New Haven, Connecticut, United States Saint Francis Health System Full timeJob SummaryThe Clinical Nurse I is responsible for assessing, planning, implementing, and evaluating nursing care for patients in the Neuroscience unit. This role requires a strong understanding of general disease state management processes, bio-psychosocial models, and clinical pathways.Key ResponsibilitiesUtilize the nursing process to care for patients,...