CVS Health
Remote/Telecommute
Prior Authorization Nurse Consultant - Utilization Management RN
Posted over 1 month ago
Job Description
Job Description
Fully remote position - open to candidates located in Louisiana.
Schedule is Monday - Friday, standard business hours.
Rotational weekends Saturday & Sunday required.
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits. Develops, implements and supports health strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness.
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.
Required Qualifications
- RN with current unrestricted state licensure
- 3+ years of clinical experience
- Managed care, utilization review, and/or prior authorization experience
- Position requires proficiency with computer skills, navigating multiple systems, and keyboarding
- Ability to work in fast-paced environment
Preferred Qualifications
- Clinical precertification experience
- Home health care experience
- Case management experience
Education
- Associate's degree required
- BSN preferred
- RN with current unrestricted state licensure required
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.
Fully remote position - open to candidates located in Louisiana.
Schedule is Monday - Friday, standard business hours.
Rotational weekends Saturday & Sunday required.
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits. Develops, implements and supports health strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness.
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.
Required Qualifications
- RN with current unrestricted state licensure
- 3+ years of clinical experience
- Managed care, utilization review, and/or prior authorization experience
- Position requires proficiency with computer skills, navigating multiple systems, and keyboarding
- Ability to work in fast-paced environment
Preferred Qualifications
- Clinical precertification experience
- Home health care experience
- Case management experience
Education
- Associate's degree required
- BSN preferred
- RN with current unrestricted state licensure required
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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