Aetna UM Nurse Consultant in Hartford, Connecticut

Req ID: 41599BR

POSITION SUMMARY

As a Utilization Management (UM) Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.

Fundamental Components include, but are not limited to:

-Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care

-Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)

-Identifies members who may benefit from care management programs and facilitates referral Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

-Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

BACKGROUND/EXPERIENCE

Managed Care experience preferred 3-5 years of clinical experience required e.g., hospital setting, alternative care setting such as home health or ambulatory care required

Registered nurse (RN) with unrestricted state license.

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

Functional - Nursing/Medical-Surgical Care/4-6 Years

Functional - Nursing/Home Health Care Ambulatory Nursing/1-3 Years

Functional - Nursing/Discharge Planning/1-3 Years

Functional - Nursing/Critical Care/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Turning Data into Information/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

Benefits Management/Supporting Medical Practice/ADVANCED

General Business/Consulting for Solutions/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

One UMNC will support the New England market. (position may be office based with ability to become telework)

One UMNC will support the New Jersey market. (No office in New Jersey to support office based nurse so the New Jersey nurse will be telework)

ADDITIONAL JOB INFORMATION

Full-Time Telework (WAH). May need to attend in office meetings/trainings as needed.

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.

Job Function: Health Care