Job Description
Job Description
This is a telework role. Required hours are Monday-Friday 8am-5pm EST with flexibility to work late shift until 8pm EST on rotation.
Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for complex spinal procedures requiring precertification. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.
Required Qualifications
- Active and good standing RN license
- 3+ years of clinical experience
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Sedentary work involves periods of sitting, talking, listening and use of the computer
- Ability to work in a fast paced environment
Preferred Qualifications
- Clinical precertification experience
- Managed care/utilization review/experience
- Case Management experience
- Home health care experience
Education
Bachelor's or Associate's degree in Nursing
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 is a telework role. Required hours are Monday-Friday 8am-5pm EST with flexibility to work late shift until 8pm EST on rotation.
Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for complex spinal procedures requiring precertification. The majority of the time is spent at a desk and on the telephone collecting & reviewing clinical information from providers. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.
Required Qualifications
- Active and good standing RN license
- 3+ years of clinical experience
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Sedentary work involves periods of sitting, talking, listening and use of the computer
- Ability to work in a fast paced environment
Preferred Qualifications
- Clinical precertification experience
- Managed care/utilization review/experience
- Case Management experience
- Home health care experience
Education
Bachelor's or Associate's degree in Nursing
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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