UM Nurse Consultant-CA

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

Required Qualifications
3-5 years of clinical experience required
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.

Position is salaried however must be willing to clock in and out.

Working hours Monday - Friday 8am-4:30pm
Must be wiling to work weekends and holidays on occasion.

Preferred Qualifications
Managed Care experience preferred

Education
Prefer 3+ years 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.