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CategoryHealthcare
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No of Jobs1
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Apply Before10/01/2025
Description
Utilization Management Nurse Consultant - Fully Remote
The Muse - Hartford, CT
Job Title: Utilization Management Nurse Consultant - Fully Remote
Position: Clinical Telephone Queue Nurse
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30 AM - 8:00 PM EST; 8:30 AM - 5:00 PM PST; 9:30 AM - 6:00 PM MST
Work Type: Remote
Location
Address:
City: Hartford
State: CT
ZIP Code:
Job Responsibilities
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Assesses, plans, implements, coordinates, monitors and evaluates options to facilitate appropriate healthcare services/benefits for members.
- Gathers clinical information and applies the appropriate clinical criteria/guideline to render coverage determination/recommendation.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with other products, services and/or programs.
- Promotes quality effectiveness of healthcare services and benefit utilization.
- Consults and lends expertise to other internal and external constituents in the administration of the utilization/benefit management function.
- Functions in a clinical telephone queue working with providers to secure additional information for prior authorization review.
Required Skills
Core Skills
- Utilization Management
- Clinical judgment
- Clinical documentation systems
- Communication with healthcare providers
Preferred Skills
- Managed Care experience
- High volume clinical call center experience
- Remote work experience
Requirements
Experience: 1 year UM, concurrent review or prior authorization; 5 years of clinical experience
Education: Associate's nursing degree (RN) minimum required; Bachelor's degree preferred
License & Certification:
- Registered Nurse license in state of residence
- Multi-state/compact privileges
Schedule:
- Regular shifts Monday-Friday; weekend/holiday coverage occasionally required
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with matching contributions
- Employee stock purchase plan
- No-cost programs for wellness screenings, tobacco cessation, weight management, confidential counseling, and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for CVS Health bonus, commission or short-term incentive program
Special Notes
- Commitment to fostering a workplace where every colleague feels valued and that they belong.
- Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Facility Details
Name: The Muse
Description: A medical management company and a division within Aetna/CVS Health, URAC accredited in multiple management services.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: Delivering flexible medical management services that support cost-effective quality care for members.
Job Info
