UM Nurse Consultant

Job Description
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.

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
Effective communication skills, both verbal and written.

Required Qualifications
* RN with current unrestricted state licensure required
* 3-5 years of clinical experience required
Managed Care experience preferred
* Strong technical proficiency including navigating multiple systems and keyboarding

Preferred Qualifications
Managed Care experience preferred

Education
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.