Utilization Management Nurse Consultant - Fully Remote

CVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. You will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.

Key Responsibilities

• Review services to assure medical necessity and appropriate benefit utilization.
• Facilitate safe and efficient discharge planning and work closely with facilities and providers.
• Facilitate the delivery of appropriate benefits and healthcare information.
• Develop and implement health strategies, policies, and programs.
• Gather clinical information and apply appropriate clinical criteria and guidelines.
• Communicate with providers and other parties to facilitate care and treatment.

Required Qualifications

• Registered Nurse (RN) with current unrestricted US licensure.
• 2+ years clinical practice experience as an RN.
• 2+ years Utilization Management experience.

Education

• Associate’s degree in Nursing required (BSN preferred).