Aetna UM Nurse Consultant in Philadelphia, Pennsylvania
Req ID: 53506BR
This role is open to candidates across the US. Telework will only be considered for current internal teleworkers.
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 role will specifically involve working with Medicare pre-certifications.
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
RN licensure required
3+ years clinical experience required in a hospital setting
Utilization management experience preferred
Managed Care experience 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 in a virtual environment - and adjust to change
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 - Nursing/Medical-Surgical Care/1+ Years
Functional - Nursing/Concurrent Review/discharge planning/1+ Years
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
General Business/Turning Data into Information/FOUNDATION
Considered only for current internal teleworkers (in any area)
ADDITIONAL JOB INFORMATION
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
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.