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Job DescriptionThe required schedule will be between 8am-7pm CST. Weekend coverage will occasionally be required. Applicants must be comfortable working CST hours.This is a fully telework role.Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care- Communicates with providers and other parties to facilitate care/treatment- Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functionRequired QualificationsRN with current unrestricted state licensure required- 3+ years of clinical experience required- Managed Care experience preferred
Preferred QualificationsPlease review required qualifications aboveEducationBachelor's degree or equivalent experienceBusiness OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
