Aetna Inc.

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Utilization Management Nurse Consultant

at Aetna Inc.

Posted: 9/24/2019
Job Reference #: 68367

Job Description

Job Description
Telework Opportunity, open to all locations

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

Req#
63952BR

Job Group
Healthcare

Full or Part Time
Full Time

Supervisory Responsibilities
No

Percent of Travel Required
0 - 10%

Posting Job Title
Utilization Management Nurse Consultant

Potential Telework Position
Yes

Additional Locations
AZ-Scottsdale, CA-Woodland Hills, CT-New Haven, IL-Chicago, MO-Chesterfield, OH-Richfield, OR-Portland, VA-Charlottesville

Primary Location (City, State)
CT-New Haven

EEO Statement
Aetna is an Equal Opportunity, Affirmative Action Employer

Resource Group
6

Initiative Group
89

Additional Job Information
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Fundamental Components
Utilizes 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 Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Background Experience
3+ years of clinical experience required
Post Acute experience preferred
Managed Care experience preferred 
RN with current unrestricted state licensure required

Required Skills
Benefits Management - Maximizing Healthcare Quality, General Business - Demonstrating Business and Industry Acumen, Leadership - Driving a Culture of Compliance

Desired Skills
Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment, General Business - Communicating for Impact

Minimum Functional Experience
Management - Management - Health Care Delivery, Medical Management - Medical Management - Hospital, Nursing - Concurrent Review/discharge planning

Minimum Technical Experience
Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

Minimum Education Level
Nursing - Registered Nurse (RN)

Benefits Program
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information
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.