Aetna Registered Nurse (RN) - Utilization Management Nurse Consultant in Fresno, California

Req ID: 53981BR

POSITION SUMMARY

The Utilization Management Nurse Consultant utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations working in a very fast paced environment.

This position is for the nurse who wants challenge in a fast paced, always changing environment. The nurse uses their clinical knowledge, communication skills and independent critical thinking skills towards interpreting criteria and policies and procedures to provide the best and most appropriate treatment, care and services for members. This position is based on a 40 hour week Monday through Friday. The hours of operation are between 8am - 5pm EST.

Fundamental Components:

The UM Nurse Consultant applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. The UM Nurse Consultant coordinates and communicates with providers, members and other parties to facilitate optimal care and treatment often collaborating with Aetna medical directors and other internal departments.They identify members who may benefit from care management programs and facilitates referrals as well as identify opportunities to promote quality effectiveness of healthcare services and benefit utilization. The UM nurse Consultant utilizes their technical skills to multitask through multiple systems at a rapid pace in order to process Precert requests timely and accurately. They are proficient in both verbal and written communication in order to request information, review clinical material, make appropriate decisions based on medical necessity and/or benefits and communicate those decisions to both providers and members

Required Background/Experience:

  • RN licensure is required

  • 3+ years of clinical experience in a hospital setting is required

    Preferred Background/Experience:

  • Pre-certification experience is preferred

  • Utilization management experience is preferred

  • Managed care experience is preferred

  • Excellent computer skills able to multi task and navigate multiple computer systems including Outlook, Word and Excel - Excellent verbal/written communication skills

  • Able to work independently and adjust to change

    EDUCATION

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

    LICENSES AND CERTIFICATIONS

    Nursing/Registered Nurse is required

    FUNCTIONAL EXPERIENCES

    Functional - Nursing/Medical-Surgical Care/1+ Years

    Functional - Nursing/Concurrent Review/discharge planning/1+ Years

    TECHNOLOGY EXPERIENCES

    Technical - Computer Operations/System and Console Operations/1+ Years/End User

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

    Technical - Desktop Tools/Microsoft Word/1+ Years/End User

    REQUIRED SKILLS

    Technology/Leveraging Technology/FOUNDATION

    DESIRED SKILLS

    General Business/Turning Data into Information/FOUNDATION

    Telework Specifications:

    Considered only for current internal teleworkers (in any area).

    ADDITIONAL JOB INFORMATION

    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.