Aetna UM Nurse Consultant in San Antonio, Texas

Req ID: 55577BR

POSITION SUMMARY

Utilizes clinical skills to review claims for medical necessity and coding edits.

Fundamental Components:

Utilizes clinical experience and skills in a collaborative process. Gathers clinical information and applies the appropriate clinical criteria / guideline, policy, and procedure using clinical judgment to render coverage determination.

BACKGROUND/EXPERIENCE desired:

Requires RN with unrestricted license. 3+ years of clinical experience required. Managed Care experience preferred Requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, verbal and written. Able to work in a team environment. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Typical office working conditions with productivity and quality expectations.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

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

Functional - Nursing/Clinical coverage and policies/1+ Years

Functional - Nursing/Clinical claim review and coding/1+ Years

TECHNOLOGY EXPERIENCES

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

Technical - Desktop Tools/Microsoft Explorer/1+ 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

Leadership/Driving a Culture of Compliance/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

ADDITIONAL JOB INFORMATION

40 hour work week, Monday through Friday. Allows the RN to make significant impact to the healthcare of the people we serve.

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.