Masters in Home Care is seeking an experienced and mission-driven Utilization Review Manager (UR Manager) to oversee our Start of Care (SOC) nurses and support clinical excellence across all episodes of care. This position ensures efficient, clinically appropriate utilization of services, accurate and compliant documentation, and effective interdisciplinary coordination. The UR Manager plays a key role in maintaining operational efficiency, optimizing clinical outcomes, and fostering collaboration among nursing, therapy, and quality teams.

Key Responsibilities:

• Supervise and support Start of Care (SOC) nurses to ensure consistency, compliance, and quality in clinical assessments.
• Conduct utilization reviews to verify medical necessity, visit frequencies, and plan-of-care alignment.
• Coordinate and develop disease-specific clinical pathways (e.g., wound care, chronic disease, post-acute transitions) and train staff on their implementation.
• Lead interdisciplinary collaboration and case conferences to promote coordination of care and individualized treatment planning.
• Monitor documentation quality, visit utilization, and medical supply costs to meet agency benchmarks and payer standards.
• Partner with Quality Assurance and Clinical Education teams to identify training opportunities and implement process improvements.
• Provide ongoing staff education and competency development sessions related to utilization, documentation, and clinical best practices.
• Track and analyze utilization trends, including wound-care frequency, LUPA thresholds, and episode performance.
• Communicate effectively with clinicians, physicians, and branch leadership to determine the best course of treatment for each individual patient.
• Ensure regulatory and payer requirements are understood and followed by Start of Care nurses.

Qualifications:

• Current Connecticut Registered Nurse (RN) license (required).
• Bachelor’s degree in nursing or related field preferred; Master’s degree a plus.
• Minimum of five (5) years of clinical experience in home health or a related healthcare setting, including at least two (2) years in utilization management, documentation oversight, or a supervisory role.
• Demonstrated clinical expertise and ability to communicate effectively with other clinicians to guide individualized patient care decisions.
• Strong understanding of Medicare Conditions of Participation (CoPs), Low Utilization Payment Adjustments (LUPAs), payer utilization requirements, and cost management strategies.
• Clinical specialty certifications preferred (e.g., Wound Care Certification, Certified Case Manager (CCM/ACM), Utilization Review certification).
• Excellent leadership, analytical, and communication skills.
• Proven ability to manage utilization and control medical supply costs while maintaining high standards of care.
• Proficiency in EMR systems and ability to interpret and act on clinical data reports.
• Valid driver’s license and reliable transportation required.

Masters In Home Care offers a competitive salary and a generous benefits package for full-time employees, recognizing your vital contribution to our team:

• Salary Range: $100,000-$115,000
• Comprehensive Medical, Dental, and Vision insurance options.
• 401(k) retirement plan, including a company match (eligibility period applies)
• Generous paid time off (PTO) that rolls over annually, plus Floating Holidays.
• Life Insurance and Short Disability insurances.

About Masters in Home Care:

Masters in Home Care is a locally owned, Connecticut-based home health agency known for its compassionate, patient-centered care, strong clinical outcomes, and low rehospitalization rates. We are a multi-year Top Workplaces Award winner recognized for our supportive culture, teamwork, and commitment to excellence in serving our patients and community.

We are an equal opportunity and affirmative action employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Job Type: Full-time

Work Location: In person