Aetna RN- Utilization Management Consultant - Registered Nurse in Downers Grove, Illinois

Req ID: 43476BR


The utilization management nurse consultant utilizes 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. You will work with the Medicaid population and have interaction with providers. This is a role for someone who enjoys computer work and enjoys speaking with providers!

This is a chance to:

Have exposure to various clinical reviews To join a team of highly motivated clinicians To have exposure to multidisciplinary rounds Have avenues for internal growth/leadership opportunities

You will gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care

This position will need some weekends and you can obtain a per diem rate or a day off when working a weekend. Typical hours are Monday-Friday 8-5. This is an in office only role.

Fundamental Components:

Communicates with providers and other parties to facilitate care/treatment

Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

You will conduct concurrent reviews.


Managed Care experience preferred 3-5 years of clinical experience required Inpatient (Hospital) experience is required ICU, ER or Med/Surg are highly preferred! Strong computer and typing skills are needed! Must know Word and Outlook!


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


Nursing/Registered Nurse (RN)


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