Aetna Utilization Mangagement Nurse Consultant in Sunrise, Florida
Req ID: 42814BR
The work setting is a fast paced environment where the nurse will be conducting UM onsite reviews and SNF, Rehab and LTACH admissions at a Broward County hospital system.
Utilizes 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. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Florida State Registered Nursing License Required
3-5 years of clinical experience required
Managed Care experience preferred
Concurrent Review/Discharge Planning experience preferred
Milliman Care Guidelines experience preferred
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is desired
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Technical - Operating Systems/Windows/1-3 Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
This will be an onsite position in Broward County Florida for a large hospital system.
ADDITIONAL JOB INFORMATION
Onsite position in Broward County Florida
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