Aetna UM Nurse Consultant in San Antonio, Texas

Req ID: 44525BR

This position is open for telework in KS, MO, OK, or TX.

POSITION SUMMARY

The Registered Nurse (RN) - Utilization Management Nurse Consultant utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations working in a very fast paced environment.

Fundamental Components of the UM Nurse Consultant Include, but are not limited to:

The UM Nurse Consultant applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. The UM Nurse Consultant coordinates and communicates with providers, members and other parties to facilitate optimal care and treatment both telephonically and on-site often collaborating with Aetna medical directors and other internal departments. They identify members who may benefit from care management programs and facilitates referrals as well as identify opportunities to promote quality effectiveness of healthcare services and benefit utilization. The UM nurse Consultant utilizes their technical skills to multitask through multiple systems at a rapid pace in order to process Utilization Management requests for Concurrent Review and Discharge Planning timely and accurately. They are proficient in both verbal and written communication in order to request information, review clinical material, make appropriate decisions based on medical necessity and/or benefits and communicate those decisions to both providers and members

BACKGROUND/EXPERIENCE desired:

  • Licensed Registered Nurse required

  • 3-5 years clinical experience in a hospital setting that includes Medical/Surgical areas

  • 1-3 years Managed Care experience preferred

    Excellent computer skills able to multi task and navigate multiple computer systems including Outlook, Word and Excel Excellent verbal/written communication skills

    Able to work independently in a virtual environment and adjust to change

    EDUCATION

    The minimum 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 desired

    FUNCTIONAL EXPERIENCES

    Functional - Nursing/Clinical coverage and policies/1-3 Years

    Functional - Nursing/Legal and benefit interpretation/1-3 Years

    Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4-6 Years

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

    TECHNOLOGY EXPERIENCES

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

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

    Technical - Computer Operations/System and Console Operations/4-6 Years/End User

    REQUIRED SKILLS

    Benefits Management/Maximizing Healthcare Quality/FOUNDATION

    Finance/Managing Aetnas Risk/FOUNDATION

    Technology/Leveraging Technology/FOUNDATION

    DESIRED SKILLS

    General Business/Applying Reasoned Judgment/ADVANCED

    Leadership/Driving a Culture of Compliance/FOUNDATION

    Service/Providing Solutions to Constituent Needs/ADVANCED

    Telework Specifications:

    Considered only for current internal teleworkers Kansas, Missouri and Texas.

    ADDITIONAL JOB INFORMATION

    This position is for the nurse who wants challenge in a fast paced, always changing environment. The nurse uses their clinical knowledge, communication skills and independent critical thinking skills towards interpreting criteria and policies and procedures to provide the best and most appropriate treatment, care and services for members.

    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