CVS Health Utilization Management Clinical Consultant in Phoenix, Arizona
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.
Schedule is Monday-Friday standard business hours and mountain time.
No nights, no weekends and no holidays!
Local travel to the local Aetna Phoenix, Arizona office for meetings & trainings, etc as needed.
Full or Part Time:
Percent of Travel Required:
0 - 10%
Posting Job Title:
Utilization Management Clinical Consultant RN Registered Nurse
Potential Telework Position:
Primary Location (City, State):
Aetna is an Equal Opportunity, Affirmative Action Employer
Additional Job Information:
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
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care. Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members. Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment. Identifies members who may benefit from care management programs and facilitates referral. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
2 years or more nursing clinical practice experience, e.g., acute hospital setting, alternative care setting such as home health or ambulatory care required.
Must be Arizona resident.
Managed care/utilization review, concurrent review, or prior authorization experience preferred
Self driven and independent worker
Proficiency in technology and utilizing software
Superior customer service & communication skills
Must have expert time management & organization skills
Registered Nurse (RN) with active, in good standing & unrestricted state of Arizona license in state of service.
Benefit eligibility may vary by position.
Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Clinical Licensure Required: