Aetna UM Nurse Consultant in San Antonio, Texas
Req ID: 43562BR
This position is for a Utilization Manager with Aetnas Care Management program in the Public & Labor Dedicated Unit.The hours of operation are 8:00 am to 9:00 pm EST. It requires an Evening Shift rotation 1:30 pm to 9:00 pm 1-2 times per month. Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.
Fundamental Components include, but are not limited to:
Utilization Management Nurse Consultant will be able to utilize 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. The UMNC will gather clinical information and apply the appropriate clinical criteria, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. The UMNC communicates with providers and other parties to facilitate care/treatment and lends expertise to other internal and external constituents in the coordination and administration of the utilization management function. UMNC will work collaboratively with the other members of the care advocate team. Requires an RN with unrestricted active license. Minimum 3 to 5 years of clinical experience. Must possess strong verbal, written communication skills, computer and keyboarding skills.
Managed Care experience; preferred
3-5 years of clinical experience; required
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 required
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Nursing/Discharge Planning/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User
Interacting with Medical Professionals
Maximizing Healthcare Quality
Supporting Medical Practice
Consulting for Solutions
Providing Solutions to Constituent Needs
ADDITIONAL JOB INFORMATION
We are looking for a Utilization Manager to join the Public & Labor Dedicated Unit. Our department is a rapidly growing fast paced environment that provides our teams the opportunity to make a positive impact for our members and customers. The role is office based with extensive telephonic and computer utilization. We are seeking an individual who is adaptable and innovative with strong clinical skills that focus on the well-being of our 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.
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Job Function: Health Care