Aetna UM Nurse Consultant in San Antonio, Texas
Req ID: 44266BR
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies
UM Nurse Consultants require: - Effective communication skills, both verbal and written, and the ability to effectively and credibly discuss routine and complex care situations with both external and internal clinicians. - Intellectual humility, empathy, integrity, courage, and confidence to drive fair and purposeful and appropriate decisions. - The ability to prioritize and effectively adapt to a fast paced changing environment. - Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
*Managed Care experience preferred *3-5 years of clinical experience required *Utilization Management experience preferred. *Excellent Computer Skills *Excellent Time Management Skills
The minimal level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Nursing/Case Management/1-3 Years
Technical - Desktop Tools/Microsoft Word/4-6 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User
Technical - Desktop Tools/Microsoft Explorer/4-6 Years/End User
Technical - Computer Operations/System and Console Operations/4-6 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
NO work at home for this position
ADDITIONAL JOB INFORMATION
This is a fast paced unit with participants who often have complex nursing needs. Our UMNCs must be able to work efficiently with Case manager ,providers, vendors ,participants, and families to determine gaps in medical care and be able to assist in comprehensive discharge planning. This is a team dedicated to the plan sponsor .
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