UM Nurse Consultant

Employer
CVS Health
Location
Nevada
Salary
Competitive
Posted
Feb 20, 2021
Closes
Mar 22, 2021
Ref
1465897BR
Specialty
Other
Contract Type
Permanent
Job Description
This position will be working from home but the employee must be located in Pacific Time.

*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 function.

Required Qualifications
*3+ years of clinical experience required
*RN with current unrestricted state licensure required.

Preferred Qualifications
* Managed Care experience preferred

Education
Associate's degree or equivalent experience

Business Overview
At 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.

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