Aetna UM Nurse Consultant in New Albany, Ohio
Req ID: 50019BR
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.
We are looking for a Utilization Management Nurse Consultant to join the New Albany Dedicated Unit. In the Utilization Management Nurse Consultant role we are looking for a candidate who 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 recent experience. Must possess strong verbal, written communication skills, computer and keyboarding skills.
BACKGROUND/EXPERIENCE: Managed Care experience; Preferred3-5 years of clinical experience; RequiredProficient in navigating between multiple systems with dual monitors. Accurately touch type on a keyboard at efficient speed; RequiredEDUCATION
The minimum level of education required for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Registered Nurse (RN) License; Required
Functional - Nursing/Critical Care/1-3 Years
Functional - Nursing/Clinical coverage and policies/1-3 Years
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Operating Systems/Windows/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Service/Providing Solutions to Constituent Needs/ADVANCED
ADDITIONAL JOB INFORMATION
The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred. Candidate must possess good computer skills. Hours of operation are 8:00 AM to 10:00 PM EST Monday - Friday. Evening Shift rotation (1:30 PM to 10:00 PM) 1-2 times a month.
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.
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Job Function: Health Care