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Remote Optum Utilization Review Jobs in Connecticut

Gateway Recruiting

Territory Manager

Hartford, CT · Remote

Conduct quarterly business reviews with key accounts to assess performance and identify growth ... Remote monitoring workflow development, Utilization ramp and adoption metrics * Strong executive ...

Gateway Recruiting

Territory Manager

New Haven, CT · Remote

Conduct quarterly business reviews with key accounts to assess performance and identify growth ... Remote monitoring workflow development, Utilization ramp and adoption metrics * Strong executive ...

ADNET Technologies

TAC Helpdesk Engineer

Rocky Hill, CT · Remote

Every application submitted through Workday is reviewed by a real person, not an AI. We value your ... Provide remote and occasional on-site Level 2 technical support to ADNET clients through telephone ...

ADNET Technologies

TAC Helpdesk Engineer

Rocky Hill, CT · Remote

Every application submitted through Workday is reviewed by a real person, not an AI. We value your ... Provide remote and occasional on-site Level 2 technical support to ADNET clients through telephone ...

JLL

PDS Strategic Sourcing Specialist

Hartford, CT · On-site +1

Participate and provide leadership to Preferred Supplier performance review meetings. * Support JLL ... Location: Remote -Boston, MA, Hartford, CT, New York, NY, Pittsburgh, PA, Providence, RI ...

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Remote Optum Utilization Review information

What is a Remote Optum Utilization Review?

A Remote Optum Utilization Review position involves working for Optum, a healthcare services company, to evaluate medical records and determine the necessity and appropriateness of healthcare services. Employees in this role review clinical documentation to ensure that treatments meet established guidelines and help to manage healthcare costs while ensuring patient care is not compromised. The position is remote, meaning you can work from home or another location outside of a traditional office. Utilization review professionals often interact with healthcare providers, insurance companies, and patients, using their clinical expertise to make informed decisions.

What are the key skills and qualifications needed to thrive as a Remote Optum Utilization Review nurse?

To thrive as a Remote Optum Utilization Review Nurse, you need a current RN license, strong clinical judgment, knowledge of utilization management, and experience in case review or discharge planning. Proficiency with medical review software, electronic health records, and familiarity with UM guidelines such as InterQual or Milliman is typically required. Exceptional communication, attention to detail, and critical thinking are vital soft skills for effective collaboration and decision-making in a remote environment. These skills ensure accurate assessments, regulatory compliance, and optimal patient outcomes while maintaining efficiency in a virtual workflow.

How does a Remote Optum Utilization Review nurse typically collaborate with multidisciplinary teams while working from home?

As a Remote Optum Utilization Review nurse, collaboration with multidisciplinary teams is primarily conducted through secure digital platforms, including video calls, emails, and electronic health record systems. You’ll regularly communicate with physicians, social workers, case managers, and other healthcare providers to review patient cases, coordinate care plans, and ensure compliance with clinical guidelines. Despite working remotely, maintaining clear and timely communication is essential for effective patient advocacy and decision-making. Team meetings and case discussions are scheduled virtually, fostering a supportive environment and ensuring you stay connected to the broader healthcare team.

What is the difference between Remote Optum Utilization Review vs Remote UnitedHealthcare Utilization Review?

AspectRemote Optum Utilization ReviewRemote UnitedHealthcare Utilization Review
CredentialsLicenses in relevant states, certifications like CCM or CRC often preferredLicenses in relevant states, certifications like CCM or CRC often preferred
Work EnvironmentRemote, home-based with flexible hoursRemote, home-based with flexible hours
Employer & IndustryOptum, healthcare services and utilization managementUnitedHealthcare, health insurance and utilization review

Both roles involve reviewing healthcare claims and authorizations remotely, requiring similar credentials and work environments. The main difference lies in the employer and specific healthcare focus: Optum specializes in healthcare services and utilization management, while UnitedHealthcare focuses on health insurance and claims review. Candidates often compare these roles to determine the best fit based on employer and industry specialization.

What are the most commonly searched types of Optum Utilization Review jobs in Connecticut?

The most popular types of Optum Utilization Review jobs in Connecticut are:

What are popular job titles related to Remote Optum Utilization Review jobs in Connecticut?

For Remote Optum Utilization Review jobs in Connecticut, the most frequently searched job titles are:

What job categories do people searching Remote Optum Utilization Review jobs in Connecticut look for?

The top searched job categories for Remote Optum Utilization Review jobs in Connecticut are:

What cities in Connecticut are hiring for Remote Optum Utilization Review jobs?

Cities in Connecticut with the most Remote Optum Utilization Review job openings:

Remote Optum Utilization Review jobs near you
Infographic showing various Remote Optum Utilization Review job openings in Connecticut as of August 2026, with employment types broken down into 77% Full Time, 13% Part Time, and 10% Contract. Highlights an 100% Remote job distribution.

Director, Quality Systems & Regulatory Affairs (Remote - East Coast)

CEFALY Technology

Darien, CT • On-site, Remote

$160K - $180K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

Job description

Director, Quality Systems & Regulatory Affairs
Department: Quality & Regulatory Affairs
Reports To: SVP, Operations
Location: Remote or Hybrid - East Coast ONLY
FLSA Status: Exempt, Full-Time
Position Summary
CEFALY Technology is seeking an experienced Quality Systems & Regulatory Affairs leader to strengthen and scale the organization's quality and regulatory infrastructure. This individual will serve as the functional lead for Quality Systems and Regulatory Affairs and will be responsible for improving organizational compliance, strengthening audit readiness, and reducing quality system risk through robust process ownership and execution.
A critical priority for this role will be optimizing and expanding the company's electronic Quality Management System (eQMS), conducting comprehensive assessments of quality documentation and system effectiveness, and driving sustainable process improvements across the organization. This position will provide experienced leadership during notified body audits and regulatory inspections and will help build long-term organizational capability through mentorship and process maturity.
The role serves as a strategic and hands-on partner across Operations, Supply Chain, Customer Service, Product Development, and leadership teams to ensure compliance excellence and scalable growth.
Essential Responsibilities
Quality Management System (QMS) & eQMS Leadership
  • Serve as system owner and business lead for the organization's eQMS platform including optimization, implementation expansion, workflow design, governance, and user adoption.
  • Assess current eQMS utilization and develop a roadmap for full implementation and process maturity.
  • Own and administer day-to-day QMS and eQMS activities and processes.
  • Lead continual improvement initiatives across quality system processes and documentation.
  • Lead comprehensive audits of controlled documentation and quality records to identify inconsistencies, gaps, obsolete content, and systemic documentation deficiencies.
  • Establish processes and controls ensuring consistency across SOPs, work instructions, forms, labels, templates, and quality records.
  • Drive document control processes including creation, revision workflows, review cycles, training assignments, archival activities, and change management.
  • Develop sustainable document governance practices to reduce repeat nonconformances and improve inspection readiness.
  • Monitor quality metrics and identify opportunities for process improvements.
  • Support and improve CAPA, nonconformance, complaint handling, change control, risk management, and supplier quality processes.
  • Ensure QMS alignment with ISO 13485, FDA Quality System Regulation (21 CFR Part 820/QMSR), EU MDR, and applicable global requirements.
  • Lead initiatives to improve quality system effectiveness, data integrity, and organizational compliance maturity.
  • Maintain ongoing inspection and audit readiness.

Audit & Compliance Leadership
  • Act as primary Quality and Regulatory lead during notified body audits, FDA inspections, supplier audits, and external quality assessments.
  • Lead audit preparation strategy, evidence collection, coordination activities, and response management.
  • Drive audit finding remediation through root cause analysis and sustainable CAPA implementation.
  • Support management review processes and quality reporting.
  • Maintain a continuous state of organizational inspection readiness.

Regulatory Affairs Leadership
  • Independently lead FDA and international regulatory submissions and agency interactions.
  • Prepare, coordinate, and execute regulatory filings and lifecycle submissions.
  • Conduct regulatory impact assessments related to product, process, manufacturing, supplier, labeling, and operational changes.
  • Provide regulatory strategy recommendations and communicate business impact to leadership.
  • Support registrations, renewals, amendments, and post-market regulatory activities.
  • Interpret changing regulatory requirements and proactively communicate implications.
  • Maintain regulatory records and submission archives.

Leadership & Cross-Functional Partnership
  • Mentor and help develop junior QA/RA personnel.
  • Provide quality and regulatory leadership across Operations, Supply Chain, Customer Service, Product Development, and leadership teams.
  • Act as an internal subject matter expert for QMS and regulatory requirements.
  • Support employee training initiatives related to quality systems and compliance.
  • Provide guidance during business, operational, and product decisions.

Qualifications
Education
  • Bachelor's degree in Engineering, Life Sciences, Regulatory Affairs, Quality, or related field required.
  • Advanced degree preferred.

Experience
  • 8-12+ years of progressive Quality and Regulatory Affairs experience within medical devices.
  • Demonstrated experience serving as lead quality or regulatory representative during notified body audits and regulatory inspections.
  • Proven experience owning, implementing, or significantly improving an electronic QMS platform; Greenlight Guru experience strongly preferred.
  • Demonstrated experience identifying and remediating systemic documentation and quality system deficiencies.
  • Experience independently leading FDA submissions and EU MDR activities.
  • Experience with CAPA, complaint handling, risk management, supplier quality, document control, and change management systems.
  • Demonstrated success improving audit outcomes and quality system maturity.
  • Prior people leadership or mentoring experience strongly preferred.
  • Experience supporting Class II and/or Class III medical devices preferred.

Knowledge & Skills
  • Deep understanding of ISO 13485, FDA Quality System Regulation (21 CFR Part 820/QMSR), EU MDR, and related global regulations.
  • Strong understanding of quality systems architecture and eQMS administration.
  • Excellent technical writing and documentation skills.
  • Strong project management and organizational capabilities.
  • Strong leadership presence during audits and external interactions.
  • Ability to manage multiple priorities within fast-paced environments.
  • Excellent communication and cross-functional influencing skills.
  • Strong analytical, problem-solving, and systems-thinking abilities.

Preferred Certifications
  • RAC, CQE, CQA, ASQ certifications, or equivalent preferred.

Success in this role includes:
  • Complete a comprehensive assessment of current QMS and eQMS state.
  • Develop and execute a Greenlight Guru optimization roadmap.
  • Conduct a full controlled-document audit and remediation initiative.
  • Reduce repeat audit observations and documentation inconsistencies.
  • Improve notified body audit readiness and inspection confidence.
  • Strengthen quality system governance and documentation control processes.
  • Improve organizational QA/RA capability and mentorship support.
  • Build scalable infrastructure supporting future growth.

Why This Role Matters
This role is being added to strengthen organizational quality and regulatory capabilities, reduce single-point dependency risk, improve QMS sustainability, and establish scalable systems supporting long-term growth and compliance excellence.
Benefits
  • Health insurance (80% employer-paid)
  • Employer-paid Dental and Vision
  • Short-Term and Long-Term Disability
  • Group Life Insurance
  • IRA with company match (no vesting period)
  • Paid PTO
  • Paid company holidays

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