Aetna UM Nurse Associate in St Louis, Missouri

Req ID: 43651BR

POSITION SUMMARY

The Utilization Management Nurse Associate 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:

  • Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.

  • Coordinates and communicates with providers, members and other parties to facilitate optimal care and treatment often collaborating with Aetna medical directors and other internal departments.

  • Identifies 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.

  • Utilizes technical skills to multitask through multiple systems at a rapid pace in order to process Precert requests timely and accurately.

  • Proficiency 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:

  • LPN licensure required

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

  • 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 highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Nursing License is required

FUNCTIONAL EXPERIENCES

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

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

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

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

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

Technical - Aetna Applications/Aetna Strategic Data Warehouse/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

REQUIRED SKILLS

Finance/Managing Aetnas Risk/FOUNDATION

General Business/Maximizing Work Practices/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

General Business/Applying Reasoned Judgment/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION

Telework Specifications:

External candidates must be in office for at least 1 year before eligible for WAH. No WAH for internal or external candidates is automatic or guaranteed

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. This position is based on a 40 hour week Monday through Friday and is non-exempt. The hours of operation are between 8am - 8pm EST. Work hours will be determined based on candidates location with one late night per week required. Overtime may be required including weekends.

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