Aetna UM Nurse Associate in Dallas, Texas

Req ID: 52838BR

POSITION SUMMARY

Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.

Requires LPN/LVN with unrestricted active license.

Fundamental Components:

Promotes/supports quality effectiveness of Healthcare Services and benefit utilization

Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration

Collects information to support the process of rendering appropriate medical necessity/benefit determinations

Identifies members for referral opportunities to integrate with other products, services and/or programs

Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations

BACKGROUND/EXPERIENCE desired:

2+ years clinical experience required

Medical terminology experience is required

Must be comfortable working over the computer throughout the day; navigating through multiple computer screens and toggling through multiple systems

Must be open and comfortable with change

Must be a team player

2+ years managed care experience is preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Licensed Vocational Nurse (LVN) is required

OR

Nursing/Licensed Practical Nurse (LPN) is required

FUNCTIONAL EXPERIENCES

Functional - Customer Service/Customer service - production environment/4+ Years

Functional - Clinical / Medical/Precertification/4+ Years

Functional - Customer Service/Customer Service - Member Services - HMO products/4+ Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/QNXT/1+ Years/End User

Technical - Desktop Tools/Microsoft Outlook/4+ Years/End User

Technical - Desktop Tools/Microsoft Word/4+ Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Turning Data into Information/FOUNDATION

Service/Providing Solutions to Constituent Needs/FOUNDATION

DESIRED SKILLS

General Business/Applying Reasoned Judgment/FOUNDATION

Leadership/Collaborating for Results/FOUNDATION

ADDITIONAL JOB INFORMATION

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Effective communication skills, both verbal and written.

Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

Typical office working environment with productivity and quality expectations

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