CVS Health Utlization Management Clinical Consultant RN in Kansas
Concurrent Review -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.-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 including urgent or emergent interventions (such as triage / crisis support)-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
- 3+ years of clinical practice experience in an inpatient setting required- RN with unrestricted state licensure required-Willingness to obtain additional state licenses - Ability to work rotating weekends
- Managed care/utilization review experience preferred- Discharge planning experience preferred- NICU experience preferred
Bachelor's degree or equivalent experience
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.