Utilization Management Nurse Consultant RN

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Job Description
This is a full-time, telework role. Required hours are Monday-Friday 11:30am-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.

Required Qualifications
- 3 years of clinical experience required
- 3 Utilization Management experience
- RN with current unrestricted state licensure required.
- Weekend/holiday coverage will occasionally be required.
- Requires 11:30am-800pm EST shift for at least the first 12 months post completion or orientation period.
-Work in clinical telephone queue working with providers to secure additional information for prior authorization review.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
If you are vaccinated, you are required to have received at least one COVID-19 shot
prior to your first day of employment and to provide proof of your vaccination status within the first 30 days
of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days
of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with **MEMBERS ONLY**SIGN UP NOW***.
If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply
for a reasonable accommodation within the first 30 days
of your employment in order to remain employed with **MEMBERS ONLY**SIGN UP NOW***. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Preferred Qualifications
- Managed Care experience preferred
- Prior demonstrated experience working in a high volume clinical call center environment preferred
- Utilization Management experience preferred

Education
Associate's degree or equivalent experience

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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