Aetna UM Nurse Consultant in Albany, New York

Req ID: 46105BR

POSITION SUMMARY

Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Positions include Precertification, Concurrent Review, and Retro Review. Independently coordinates with the clinical resolution with internal/external clinician support as required.

Fundamental Components include but are not limited to:

UM Nurse Consultants require:

  • Effective communication skills, both verbal and written, and the ability to effectively and credibly discuss routine and complex care situations with both external and internal clinicians.

  • Intellectual humility, empathy, integrity, courage, and confidence to drive fair and purposeful and appropriate decisions.

  • The ability to prioritize and effectively adapt to a fast paced changing environment.

  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

    BACKGROUND/EXPERIENCE required:

    Managed Care experience preferred

    3-5 years of clinical (med surg) experience required

    unrestricted NYS RN license

    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 (RN) NYS is required

    FUNCTIONAL EXPERIENCES

    Functional - Medical Management/Medical Management - Discharge planning/1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

    REQUIRED SKILLS

    Benefits Management/Maximizing Healthcare Quality/FOUNDATION

    Benefits Management/Supporting Medical Practice/FOUNDATION

    Benefits Management/Understanding Clinical Impacts/FOUNDATION

    Telework Specifications:

    Option for telework will be evaluated after a certain period of employment, however, must reside in NY and within one hour of NY office.

    ADDITIONAL JOB INFORMATION

    Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

    Effective communication skills, both verbal and written.

    Ability to multitask, prioritize and effectively adapt to a fast paced changing environment

    as well as a PC monitor.

    Typical office working environment with productivity and quality expectations

    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