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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 - Remote Work
The Muse - Hartford, CT
Job Title: Utilization Management Nurse Consultant - Remote Work
Position: Clinical Management Specialist
Job Type: Full Time
Pay: $26.01 - $74.78
Shift: Monday-Friday: 11:30am-8:00pm EST; Weekend/holiday coverage will occasionally be required.
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 for appropriate healthcare services/benefits for members.
- Gathers clinical information and applies appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determinations.
- Communicates with providers and other parties to facilitate care/treatment.
- Identifies members for referral opportunities to integrate with products, services, and/or programs.
- Promotes the quality effectiveness of healthcare services and benefit utilization.
- Consults with internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Works in a clinical telephone queue with providers to secure additional information for prior authorization review.
Required Skills
Core Skills
- Clinical experience
- Utilization management
- Independent clinical judgment
- Proficient use of clinical documentation systems
Preferred Skills
- Experience in Managed Care (MCO)
- Experience in a high volume clinical call center environment
- Remote work experience
Requirements
Experience: 1 year UM, concurrent review or prior authorization and 5 years of clinical experience required.
Education: Associate's nursing degree (RN) minimum required.
License & Certification:
- Registered Nurse license in their state of residence with multi-state/compact privileges
Schedule:
- Required to attend the first 3 weeks of on-camera training with 100% participation during 8:30am-5pm Monday-Friday.
COVID-19 Requirements: Not Specified
Benefits
- Affordable medical plan options
- 401(k) plan with company matching contributions
- Employee stock purchase plan
- No-cost wellness screenings, tobacco cessation, and weight management programs
- Confidential counseling and financial coaching
- Paid time off
- Flexible work schedules
- Family leave and dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Supplemental Pay
- Eligible for a CVS Health bonus, commission or short-term incentive program
Special Notes
- Company values diversity and inclusion, committing to fostering a workplace where every colleague feels valued and belongs.
Facility Details
Name: The Muse
Description: A medical management company that delivers flexible medical management services.
Specialties:
- Case Management
- Disease Management
- Utilization Management
Mission: To transform health care, caring for people where, when, and how they choose.
Job Info
Discipline:
Department:
Status:
Sourcing
Duration:
Experience:
Career Level:
No of Jobs:
1
Apply Before:
10/01/2025
Posted:
07/01/2025
