Utilization Management Nurse Consultant RN
This is a full-time, telework role. Required hours are Monday-Friday 1130am-8pm EST
Occasional weekends and holidays required, as needed, on a rotational basis.
Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for medical services 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
- Ability to demonstrate and explain past experience delivering exemplary customer service for both internal and external customers required
- 3-5 years of clinical experience required
- RN with current unrestricted state licensure required.
- Weekend/holiday coverage will occasionally be required.
- Requires 1130am-800pm est shift for at least the first 12 months post completion or orientation period.
- Function in a clinical telephone queue working with providers to secure additional information for prior authorization review.
- Managed Care experience preferred
- Prior demonstrated experience working in a high volume clinical call center environment preferred
- Utilization Management experience preferred
Bachelor's degree or equivalent experience
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.