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 experience as a Registered Nurse with both residency and current unrestricted licensure in the state of California

Hours for this position are 9am - 6pm Pacific Standard Time
Some weekend and holiday coverage may be required

Preferred Qualifications
Managed Care experience preferred

BSN Preferred

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.