Aetna Utilization Review Jobs – CLA

DETAILS:

Job Responsibilities: Prior Authorization Clinical Reviewer

Hiring Organization: Aetna

Educational Requirements: Bachelor Degree

Industry: Private

Employment Type: Full Time

Salary: $30 – $40/Hour

Location: Mississippi, USA

DESCRIPTION

Bring your coronary heart to CVS Health. Everyone folks at CVS Health stock a single, clean reason: Bringing our coronary heart to each second of your fitness. This reason courses our dedication to supplying stronger human-centric fitness to take care of a swiftly converting world. Anchored in our brand — with coronary heart at its center — our reason sends a non-public message that how we supply our offerings is simply as critical as what we supply. Aetna Utilization Review Jobs

Our Heart At Work Behaviors™ aid this reason. We need all of us who work at CVS Health to feel empowered with the aid of using the function they play in remodeling our way of life and accelerating our capacity to innovate and supply answers to make fitness care extra non-public, handy and affordable.

Position Summary

Mercy Care is a not-for-income Medicaid managed-care fitness plan, serving Arizonans given that 1985. We offer get admission to to bodily and behavioral fitness care offerings, to folks that are eligible for Medicaid. Our contributors consist of families, children, seniors, and people who’ve developmental/cognitive disabilities. We maintain a couple of contracts with AHCCCS, Arizona’s Medicaid agency, and supply offerings during the nation. Aetna Utilization Review Jobs

Mercy Care is run via way of means of Aetna, a CVS Health enterprise. Our group of workers is hired via way of means of Aetna and CVS Health. This offers Mercy Care the assets of a countrywide organization, and nevertheless lets in us to convey our contributors the familiarity and presence of a neighborhood crew of folks that positioned our contributors on the middle of the whole thing we do. Aetna Utilization Review Jobs

This function involves:

Prior authorization evaluation of bodily and behavioral fitness associated offerings.
Utilization of medical competencies to coordinate, report and speak all elements of the usage/advantage control program.
Application of crucial questioning and information of clinically suitable treatment, evidence-primarily based totally care and clinical necessity standards for suitable usage of offerings for contributors with disabilities and unique healthcare needs.
Taking company calls associated with the previous authorization questions and making calls to contributors to tell of the insurance determination.
Gathering medical facts and making use of suitable clinical necessity standards/guideline, policy, technique and medical judgment to render insurance determination/recommendation/discharge making plans alongside the continuum of care, Aetna Utilization Review Jobs
Utilization of medical experience and competencies in a collaborative manner to assess and facilitate suitable healthcare offerings/blessings for contributors
Identification of contributors who might also additionally advantage from care control packages and facilitation of the referral
Identification of possibilities to sell excellent effectiveness of healthcare offerings and advantage usage
Sedentary work regarding intervals of sitting, talking, listening

Required Qualifications

5+ years of medical experience as RN
Must have energetic and unrestricted RN licensure withinside the nation of Arizona
Must live in MST (AZ) time zone
Must be inclined and capable of tour for in-nation conferences on uncommon occasions. Reliable transportation required. Mileage is reimbursed in step with our enterprise rate compensation policy, Aetna Utilization Review Jobs

Preferred Qualifications

Prior Utilization Management experience
Strong crucial questioning and written verbal exchange competencies.

Education

Bachelor’s Degree in Nursing required, Aetna Utilization Review Jobs

Pay Range

The usual pay variety for this function is:

$30.00 – $40.00

This pay variety represents the bottom hourly charge or base annual complete-time profits for all positions inside the activity grade inside which this function falls. The real base profits provided will depend upon a selection of things together with experience, schooling, geography and different applicable factors. This function is eligible for a CVS Health bonus, fee or short-time period incentive application similar to the bottom pay variety indexed above. Aetna Utilization Review Jobs

About Aetna

Aetna is a healthcare corporation that gives more than a few medical insurance and associated services. Aetna operates as a subsidiary of CVS Health, following a merger finished in 2018. Aetna was based in 1853 in Hartford, Connecticut, because the Aetna Life Insurance Company, initially specialized in life insurance. Over the years, Aetna has changed its services and has become a main participant in the medical insurance and controlled care industries. Aetna Utilization Review Jobs

Benefits

In addition to your compensation, experience the rewards of an agency that places our coronary heart into worrying for our colleagues and our communities. The Company provides a complete variety of medical, dental, and imaginative and prescient benefits. Eligible personnel might also additionally sign up inside the Company’s 401(k) retirement financial savings plan, and an Employee Stock Purchase Plan is likewise to be had for eligible personnel. The Company affords a fully-paid period existence coverage plan to eligible personnel, and short-time period and long-time incapacity benefits. CVS Health additionally gives several health applications, schooling assistance, unfastened improvement courses, a CVS save cut price, and cut-price applications with taking part partners. As for break day, Company personnel experience Paid Time Off (“PTO”) or excursion pay, in addition to paid vacations throughout the calendar year. Several paid vacations, unwell time and different break days are furnished constantly with applicable kingdom regulations and Company rules. Aetna Utilization Review Jobs

Key Advantages Of Joining Aetna As A Remote Worker

Joining Aetna as a remote employee gives numerous key advantages, reflecting the organization’s dedication to offering a dynamic and inclusive work environment. Some of the first-rate advantages of becoming a member of Aetna as a remote employee include:

Flexibility and Work-Life Balance: Remote work regularly presents extra flexibility in phrases of labor hours and location, permitting personnel to gain a higher work-life balance.
Reduced Commuting Stress: Remote people can keep away from commuting to a bodily workplace, lowering pressure and saving time that might in any other case be spent on transportation.
Access to a Nationwide Talent Pool: Remote work permits agencies like Aetna to faucet right into a broader skills pool, permitting them to draw professional specialists from unique geographic locations.
Technology and Connectivity Support: Companies investing in remote work regularly offer the essential era and guide to make certain remote personnel have the equipment and assets needed to carry out their jobs efficiently.
Cost Savings: Remote work can cause price financial savings for personnel, which include decreased commuting expenses, work apparel costs, and capability financial savings on meals.
Health and Safety: Especially applicable in instances of public fitness concerns, remote work can contribute to worker fitness and protection with the aid of minimizing publicity to workplace-primarily based totally environments.
Increased Productivity: Some people discover that remote work environments can decorate productiveness because of fewer place of business distractions and a greater personalized work setup.
Personalized Work Environment: Remote people can create customized and snug work surroundings tailor-made to their preferences, doubtlessly boosting process satisfaction.
Environmental Impact: Remote work can contribute to a discount on the environmental effect related to commuting because it affects fewer automobiles on the street and much less calls for workplace space.
Employee Wellness Programs: Companies like Aetna can also additionally provide remote personnel get right of entry to well-being packages that guide bodily and intellectual fitness.
Inclusion and Diversity: Remote work can contribute to fostering a greater inclusive place of business with the aid of accommodating people with unique wishes and circumstances.
Remote Collaboration Tools: Companies investing in remote work regularly offer get right of entry to collaboration equipment that facilitates powerful conversation and teamwork amongst remote teams.

Aetna Utilization Review Jobs – CLA