Insurance Jobs – UM Clinical Consultant

Found in: beBee jobs US - 7 days ago


Richmond, Virginia, United States Aetna Full time
Job Description:

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.

[ads1]
Job Responsibilities:
  • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
  • Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate.
  • Provides triage and crisis support.
  • 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 clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning.
  • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
  • Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
  • Coordinates with providers and other parties to facilitate optimal care/treatment.
Job Requirements:
  • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
  • Licensed independent Behavioral Health clinician for Virginia or a Registered Nurse (RN) with unrestricted Virginia state license with psychiatric specialty, certification, or experience
  • 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
Job Details:

Company: Aetna

Vacancy Type: Full Time

Job Location: Richmond, VA, US

Application Deadline: N/A

[ads2]

Apply Here

careers-


  • Insurance Producer in Virginia

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States Tushar Barot - Supreme Insurance Services Full time

    Insurance Producer- Salessupreme Insurance is hiring for Insurance Producers in Virginia.Supreme Insurance is a well established agency Headquarters based in Holly springs, NC.Who is an insurance producer? Insurance producer is a licensed salesperson working for an insurance agency. The main goal of the insurance producer is to acquire new customers and...

  • BigData Consultants

    Found in: beBee jobs US - 2 weeks ago


    Richmond, Virginia, United States Vedainfo Full time

    Job Role BigData Consultant with AWS Location Richmond VA Project Duration 12+ Months 2+ years- experience in Hadoop Spark Good knowledge on frameworks like Spark Beam Flink HDFS HIVE HBASE Good knowledge of SQL Good understanding of AWS components storage (S3) & compute services (EC2); hands on experience of AWS managed services (lambda Athena) and ETL...

  • Locum Tenens Job in VA for Gastroenterologist

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States Weatherby Healthcare Full time

    Start Date: ASAPIf this opportunity sounds right for you, give us a call today to speak with an expert Weatherby consultant for details.Must have active state licenseBC requiredWeekend callACLS requiredERCP requiredCredentialing neededDEA neededPaid malpractice insurance; pre-paid travel and housing expensesAssignment details and time entry in online...


  • Richmond, Virginia, United States Weatherby Healthcare. Full time

    If this opportunity sounds right for you, give us a call today to speak with an expert Weatherby consultant for details. Must have active state license BC required Weekdays, Weekends, Call General GI procedures required, ERCP is preferred and EUS is available Hospital privileges needed DEA needed Paid malpractice insurance; pre-paid travel and housing...

  • Program Analyst Wage

    Found in: beBee jobs US - 2 weeks ago


    Richmond, Virginia, United States Construction Jobs Inc Full time

    Title: Program Analyst State Role Title: Prog Admin Specialist IIHiring Range: $ $46.49 hourlyPay Band: 5Agency: VA Dept of TransportationLocation: Annex BuildingAgency Website: Recruitment Type: General Public - GJob DutiesThe Office of Land Use is seeking an individual to assist in the research, development, and coordination of agreements with broadband...

  • PeopleSoft FSCM Techno-Functional Consultant

    Found in: beBee jobs US - 2 weeks ago


    Richmond, Virginia, United States Cognizant Technology Solutions Full time

    Cognizant Technology Solutions is looking for "PeopleSoft FSCM Techno-Functional Consultant" to join in our team of IT professionals in a permanent role. If you meet our background requirements and skills and are looking for an opportunity with these skills and expertise, here is the ideal opportunity for you We are seeking out the best problem-solvers,...

  • Clinical Psychologist

    Found in: beBee jobs US - 1 day ago


    Richmond, Virginia, United States Glacier Health And Development Cent Full time

    We are actively hiring talented Clinical Testing Psychologists in Virginia, who are passionate about patient care and committed to clinical excellence.We are seeking Clinical Psychologists fully licensed and credentialed in Virginia, with a Ph.D.or Psy.D.Experienced with Pediatric Psychological Testing and/or Adult Psychological Testing.Experienced with...


  • Richmond, Virginia, United States HCA Healthcare Full time

    Description Specialization:Cardiology Non InvasiveJob Summary: Chippenham Hospital is recruiting for an exceptional non-invasive cardiologist to become part of a dynamic cardiology team providing services at Levinson Heart Hospital in Richmond, Virginia located on the Chippenham Hospital Campus. Qualified Candidates: Join 2 highly respected interventional...

  • PRN Pathology Anatomic and Clinical Physician

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States HCA Healthcare Full time

    Description Specialization:Pathology Anatomic and ClinicalJob Summary:HCA Healthcare Pathology Sevices is seeking a PRN pathologist to serve the campuses of HCA Healthcare owned hospitals in the Richmond, Virginia market.Candidate Requirements:AP/CP Board Certification or Board Eligible (required)Virginia license or FCVS in placeExcellent surgical pathology...

  • An IN Facility Needs a Locum Tenens Neurologist

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States Weatherby Healthcare Full time

    If you are seeking a new opportunity or would simply like to learn more about locum tenens, give Weatherby a call today for details.Clinic and call, no ER call15 patients per day at officeEEG and EMG requiredACLS and BLS requiredBC requiredMust have active state licenseCredentialing not neededDEA neededPaid malpractice insurance; pre-paid travel and housing...

  • Registered NurseSt Marys Clinic Days

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States VCU Health Full time

    $15,000 Sign On Bonus for offers accepted by December 31, 2023. Terms and Conditions applyThe Clinical Nurse I job integrates technical skills and theoretical knowledge to meet the needs of the patient and family. This job assists the health care team with the prevention of illness and injury, maintenance of wellness, and provision of comfort. This job...

  • Registered Nurse RN ENT Clinic Days

    Found in: beBee jobs US - 2 weeks ago


    Richmond, Virginia, United States VCU Health Full time

    $10,000 Sign-On Bonus for offers accepted by June 30, 2024. Terms and Conditions applyThis position is located at the 14th floor Multispecialty Clinic at the Adult Outpatient Pavilion (AOP) specifically within our ENT Clinic. The RN will join a small, inclusive team of RNs, LPNs and CMAs to provide care to our patients in the clinic and also in triage.The...

  • General Dentist. Job in Richmond Allied-IT Jobs

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States White House Clinics Full time

    General / Comprehensive Dentist that delivers patient care services, including assessment, diagnosis, treatment planning and coordination, monitoring and evaluation of dental care to individual patients in a variety of settings but primarily in the primary care center. Participates in fulfilling White House Clinic's mission and in meeting its responsibility...


  • Richmond, Virginia, United States Archway Physician Recruitment Full time

    OB/Gyn Opening in Richmond, IN 30 miles to Dayton, OH; 60 miles to Cincinnati, OHProvider led organization seeking a BC/BE OB/Gyn physician to join a well-established practice in Richmond, Indiana due to growth. Join a group of four board-certified OB/Gyn physicians, four nurse practitioners and one midwife. Practice includes clinic and hospital work. Office...


  • Richmond, Virginia, United States LocumTenens Full time

    Start Date:ASAPA facility with EPIC is seeking a cardiologist for locum tenens coverage. Credentialing takes about 60-90 days.The facility is located southeast of Richmond, Virginia.The schedule is Mon-Friday, 7:30am-4:00pm.Dates Needed: May - August 2024Case Load/PPD:25Shift Type: Day ShiftAssignment Type: Outpatient; ClinicAssignment Duration: LocumsCall...

  • Pathology Anatomic and Clinical Physician

    Found in: beBee jobs US - 1 week ago


    Richmond, Virginia, United States HCA Healthcare Full time

    Description Specialization:Pathology HematopathologyPathology Anatomic and ClinicalJob Summary:HCA Healthcares Capital Division is seeking an associate pathologist to join HCA Healthcare Pathology Services (HPS) to work in their pathology lab, serving the campuses of HCA Hospitals in the Richmond, Virginia Market.About the Practice:Pathology department...

  • Staff Psychologist

    Found in: beBee jobs US - 7 days ago


    Richmond, Virginia, United States Department Of Veterans Affairs Full time

    Summary The psychologist for whom this statement applies is a Clinical Psychologist with a specialty practice in the assessment and intervention of Women's Health conditions. The Clinical Psychologist will function as a full member of the Women's Health Center clinical staff and the Health Psychology/Interdisciplinary care Team. The Women's Health...

  • A Locums Obstetrics/Gynecologist Is Wanted in Virginia

    Found in: beBee jobs US - 2 weeks ago


    Richmond, Virginia, United States Weatherby Healthcare Full time

    If this opportunity sounds right for you, give us a call today to speak with an expert Weatherby consultant for details.Must have active state licenseWeekend callIn-house call coverage1069 deliveries per yearCredentialing neededDEA neededPaid malpractice insurance; pre-paid travel and housing expensesAssignment details and time entry in online...

  • Locums Gastroenterology Opportunity in IN

    Found in: beBee jobs US - 1 week ago


    Richmond, Virginia, United States Weatherby Healthcare Full time

    Start Date: ASAPIf this opportunity sounds right for you, give us a call today to speak with an expert Weatherby consultant for details.Must have active state licenseBC requiredWeekdays, Weekends, CallGeneral GI procedures required, ERCP is preferred and EUS is availableHospital privileges neededDEA neededPaid malpractice insurance; pre-paid travel and...

  • A Facility in VA Needs a Locums Obstetrics/Gynecologist

    Found in: beBee jobs US - 2 weeks ago


    Richmond, Virginia, United States Weatherby Healthcare Full time

    Start Date: ASAPInterested? Give Weatherby a call today and speak with one of our specialty-specific consultants for available dates and details.Must have active state licenseBC requiredACLS requiredHospital OB and emergency GYN procedures requiredCredentialing neededDEA neededPaid malpractice insurance; pre-paid travel and housing expensesAssignment details...