Aetna UM Nurse Consultant RN in Allentown, Pennsylvania
Req ID: 51899BR
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 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 UMNC 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 UMNC 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. -UMNC will work collaboratively with the other members of the care advocate team. -Requires an RN with unrestricted active license. Minimum 3 to 5 years of clinical experience. -Must possess strong verbal, written communication skills, computer and keyboarding skills.
Managed Care experience preferred
3-5 years of clinical experience required
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 required
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
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.
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