Aetna UM Nurse Consultant in San Antonio, Texas

Req ID: 44266BR

POSITION SUMMARY

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

Fundamental Components:

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

BACKGROUND/EXPERIENCE desired:

*Managed Care experience preferred *3-5 years of clinical experience required *Utilization Management experience preferred. *Excellent Computer Skills *Excellent Time Management Skills

EDUCATION

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 EXPERIENCES

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

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Service/Providing Solutions to Constituent Needs/ADVANCED

Telework Specifications:

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