Job Description
Job Description
This role is open for telework! Preference for candidates in the DE, WV, PA area.
-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
-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
-RN with current unrestricted state licensure.
-3+ years of clinical experience.
Typical office working environment with productivity and quality expectations. Work 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
environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written.
Preferred Qualifications
-Managed Care Experience.
-Acute-Care Experience.
Education
Associates Degree.
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.
This role is open for telework! Preference for candidates in the DE, WV, PA area.
-Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
-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
-RN with current unrestricted state licensure.
-3+ years of clinical experience.
Typical office working environment with productivity and quality expectations. Work 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
environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written.
Preferred Qualifications
-Managed Care Experience.
-Acute-Care Experience.
Education
Associates Degree.
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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