Job DescriptionUtilizes 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 clinicalinformation and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coveragedetermination/recommendation along the continuum of care Communicateswith providers and other parties to facilitate care/treatment Identifiesmembers for referral opportunities to integrate with other products,services and/or programs Identifies opportunities to promote qualityeffectiveness of Healthcare Services and benefit utilization Consults andlends expertise to other internal and external constituents in thecoordination and administration of the utilization/benefit managementfunctionPrefer applicants in the eastern or central time zones.Required Qualifications3-5 years of clinical experience requiredTypical office working environment with productivity and quality expectationsWork 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 requiressitting for extended periods, talking on the telephone and typing on thecomputer.Ability to multitask, prioritize and effectively adapt to a fast paced changingenvironmentPosition requires proficiency with computer skills which includes navigatingmultiple systems and keyboardingEffective communication skills, both verbal and written.COVID RequirementsCOVID-19 Vaccination RequirementCVS 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 CVS Health.* 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 CVS Health. 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 QualificationsManaged Care experience preferredEducationRN with current unrestricted state licensure requiredBusiness OverviewAt 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.