Aetna UM Nurse Associate in New Albany, Ohio

Req ID: 52217BR

Please note: This is an in office position in New Albany, OH

POSITION SUMMARY

Facilitates the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.

Fundamental Components:

Facilitates the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities.

Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.

Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.

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

BACKGROUND/EXPERIENCE desired:

LPN/LVN with unrestricted active license is required.

2+ years clinical experience required.

Experience and knowledge required in clinical guidelines, systems and tools i.e., MCG

2+ years managed care experience is strongly preferred

Broad-based medical and surgical background is preferred

Behavioral Health experience is strongly preferred.

Knowledge of community resources and provider networks is preferred

Familiarity with local health care delivery systems is preferred

Knowledge/Experience with Medicaid highly desired.

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 Practical Nurse (LPN) is required

OR

Nursing/Licensed Vocational Nurse (LVN) is required

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Precertification/1-3+ Years

Functional - Medical Management/Medical Management - Clinical claim review/1-3+ Years

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3+ Years

Functional - Clinical / Medical/Precertification/1-3+ Years

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