Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
Remote internals must be near one of these Aetna offices: Illinois, Michigan, Ohio, New Jersey or Virginia.
Monday-Friday standard business hours. Occasional weekend and holiday. No nights!
Promotes/supports quality effectiveness of Healthcare Services and benefit utilization Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration Collects information to support the process of rendering appropriate medical necessity/benefit determinations Identifies members for referral opportunities to integrate with other products, services and/or programs Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations
2 years clinical experience required (prior authorization, Medicare, Medicaid)
2 years managed care experience.
LPN/LVN with current unrestricted state licensure required.
Additional Job Information
Typical 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 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 environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.
Associate's degree or equivalent experience
Percent of Travel Required
0 - 10%
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.
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