Aetna Utlization Management Nurse Associate (RN or LPN) in New Albany, Ohio
Req ID: 42145BR
The Utilization Nurse Associate performs medical necessity review in response to requests for prior authorization of outpatient services. The UM Nurse Associate may be also receive incoming calls from Providers submitting requests for prior authorization of services, and make outbound calls to providers as necessary.
Fundamental Components include, but are not limited to:
Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration Collects information to support the process of rendering appropriate medical necessity/benefit determinations Identifies members for referral opportunities to integrate with other products, services and/or programs Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations
1 year or more managed care experience; Desired
2 years or more clinical experience; Required
Nursing/Licensed Practical Nurse (LPN) or RN license ; Required
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Licensed Practical Nurse (LPN) is desired
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Functional - Nursing/Home Health Care Ambulatory Nursing/1-3 Years
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Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Leadership/Collaborating for Results/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Providing Solutions to Constituent Needs/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
General Business/Applying Reasoned Judgment/FOUNDATION
General Business/Maximizing Work Practices/FOUNDATION
ADDITIONAL JOB INFORMATION
Work hours are 8:00 AM to 4:30 PM or 8:30 AM to 5:00 PM Monday through Friday.
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