Aetna Utilization Management Nurse Consultant - RN in Albany, New York

Req ID: 55113BR

POSITION SUMMARY

This position is for a Utilization Manager with Aetna's Care Management program in the Public & Labor Dedicated Unit. The nurse 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:

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 UM Nurse Consultant 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 UM Nurse Consultant 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.

  • Work collaboratively with the other members of the care advocate team.

  • Requires an RN with unrestricted active license.

  • Minimum 3 years of clinical experience.

  • Must possess strong verbal, written communication skills, computer and keyboarding skills.

BACKGROUND/EXPERIENCE:

Managed Care experience preferred

3+ years of clinical experience required

1+ years of review/discharge planning experience preferred

EDUCATION

The highest level of education preferred for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

Nursing/Certified Case Manager (CCM) is preferred

FUNCTIONAL EXPERIENCES

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

Functional - Nursing/Discharge Planning/1-3 Years

TECHNOLOGY EXPERIENCES

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

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Supporting Medical Practice/ADVANCED

Telework Specifications:

NA - Full time office based position in Albany, NY

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.

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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 candidates'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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.