Aetna Registered Nurse (RN) - Medical Underwriting Consultant in Hartford, Connecticut
Req ID: 40954BR
Join our growing team in the Hartford, CT office!
As a Medical Underwriting Consultant you will apply clinical knowledge, background, and experience while mining through clinical and claim data to project likely future treatments and their approximate costs. This helps the underwriting of the stop loss insurance (catastrophic) risk of self-funded plan sponsors with medical plans managed by third party administrators.
The Medical Underwriting Consultant will evaluate cases as assigned and join a small team of nurses that collaborate with each other as needed. The team supports Aetna Signature Administrators (ASA) and Meritain stop loss underwriting unit within TPA & Payer Solutions, a growing area of Aetnas Specialty Business segment. Our unit provides stop loss coverage through Third Party Administrator (TPA) market and currently covers over 1 million members. Our department, unit, and employees have been consistently recognized for meeting or exceeding business plan metrics.
Perform clinical risk assessment and financial analysis through reviewing medical data, medical guidelines, policy data, and claim details. The position is critical for determining risk on specific members prior to the quotes and renewals being generated by underwriters. Builds strong cross-functional relationships with internal and external constituents. Fosters open lines of communication on team, and uses effective oral and written communication skills. Support access to our Institutes of Excellence (IOE) and organ transplant repricing services. Assist in obtaining alternative arrangements if a member chooses to go outside of the Aetna IOE for transplant. Participates in project work groups including process improvement initiatives.
Registered Nurse (unrestricted active license) (Required)1+ year of Utilization and/or Case Management experience (Required)Basic computer skills, with working knowledge of Microsoft Office (Word and Excel) are preferredOncology Nurse experience and/or Certification (Preferred) End-User of ATV, ActiveAdvice, and/or iSuite (Preferred)
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN)
Functional - Nursing/Medical-Surgical Care/1-3+ Years
Functional - Nursing/Concurrent Review/discharge planning/1-3+ Years
Functional - Nursing/Case Management/1-3+ Years
If desired, can be Flexible telework/office-based schedule (must live near Hartford office location); training period in the office required. If desired, can be full-time office based (Hartford).
ADDITIONAL JOB INFORMATION
Must be detailed oriented with strong communication skills, judgment, and demonstrate good analytical ability.
Ability to manage multiple priorities.
Able to work autonomously without continual supervision.
During renewal period may be required to work more than standard hours.
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: Underwriting