Aetna UM Nurse Consultant in New Albany, Ohio

Req ID: 50019BR

POSITION SUMMARY

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.

Fundamental Components:

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 EXPERIENCES

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

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Supporting Medical Practice/ADVANCED

DESIRED SKILLS

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.

Aetna takes our candidate'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