Aetna UM Nurse Consultant in Blue Bell, Pennsylvania
Req ID: 53894BR
This exciting role is in-office out of our Blue Bell, PA location.
The UM Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
-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
-3+ years of clinical experience required
-Med/Surg experience required
-Active RN licensure required
-Strong technology skills required
-Excellent verbal and written communication skills required
-Managed Care experience preferred
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Functional - Nursing/Medical-Surgical Care/4-6+ Years
Functional - Nursing/Concurrent Review/discharge planning/1-3+ Years
Functional - Nursing/Home Health Care Ambulatory Nursing/1-3+ Years
Technical - Desktop Tools/Microsoft Outlook/1-3+ Years/End User
Technical - Desktop Tools/Microsoft Word/1-3+ Years/End User
Technical - Desktop Tools/Microsoft Explorer/1-3+ Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Leadership/Fostering a Global Perspective/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
Leadership/Collaborating for Results/ADVANCED
ADDITIONAL JOB INFORMATION
This is a challenging position that allows you to utilize your clinical skills to have a positive impact on member health opportunities.
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.