CVS Health UM Nurse Consultant in Indianapolis, Indiana
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.
Full or Part Time:
Percent of Travel Required:
0 - 10%
Posting Job Title:
Utilization Management Nurse Consultant RN
Potential Telework Position:
GA-Atlanta, IN-Indianapolis, NC-Charlotte, OH-New Albany, SC-Greenville, TX-San Antonio, VA-Roanoke
Primary Location (City, State):
Aetna is an Equal Opportunity, Affirmative Action Employer
Additional Job Information:
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.
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
3+ years of clinical experience required
Managed Care experience preferred RN with current unrestricted state licensure required.
Experience with clinical Telephone queue preferred.
Work hours 1130am-800pm EST
Benefit eligibility may vary by position.
Candidate Privacy Information:
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Clinical Licensure Required:
- CVS Health Jobs