Aetna Utilization Management Nurse Consultant in Allentown, Pennsylvania

Req ID: 43566BR

This role is office based in Allentown, PA.

POSITION SUMMARY

We help our members live fuller and healthier lives while delivering positive financial results to our plan sponsors. Through integrity, compassion and commitment to best-in-class service. We educate members, facilitate treatment plans and partner with constituents to create innovative service models.

Fundamental Components include but are not limited to:

Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates with the clinical resolution with internal/external clinician support as required. Requires and RN with unrestricted active license. Excellent communication skills- Attention to detail- Ability to multitask- Ability to problem solve- able to work within web based applications simultaneously- independent thinker.

BACKGROUND/EXPERIENCE

An RN license is required

Managed Care experience is preferred

3-5 years of clinical experience is required

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Registered Nurse is required

Nursing/Certified Case Manager (CCM) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/1-3 Years

Functional - Nursing/Case Management/1-3 Years

Functional - Nursing/Quality Management/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

Technical - Aetna Applications/Strategic Contracts Manager/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Collaborating for Results/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

ADDITIONAL JOB INFORMATION

Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates with the clinical resolution with internal/external clinician support as required. Requires and RN with unrestricted active license. Excellent communication skills- Attention to detail- Ability to multitask- Ability to problem solve- able to work within web based applications simultaneously- independent thinker.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care