Aetna UM Nurse Consultant-East or Central Time Zone Offices in Arlington, Texas

Req ID: 37161BR

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.

Candidate must be able to work a starting time of 7:30 am Central or Eastern Time.

Telework Specifications: Telework may be an option for internal candidates but is not guaranteed

Fundamental Components:

We are looking for a Utilization Management Nurse Consultant to join the North Mountain Territory Medicare SRL Team. 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 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 desired:

Managed Care experience preferred

3-5 years of clinical experience required

Proficient in navigating between multiple systems with dual monitors.

Accurately touch type on a keyboard at efficient speed. \

RN with Unrestricted License required

ATV experience desired

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required

Nursing/Certified Case Manager (CCM) is desired

Managed Care/Certified Managed Care Nurse, CMCN is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/1-3 Years

Functional - Nursing/Case Management/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 - Desktop Tools/Microsoft SharePoint/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

Technology/Leveraging Technology/FOUNDATION

Leadership/Fostering a Global Perspective/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

Telework may be an option for internal candidates but is not guaranteed

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. Business hours coverage required 7:30 AM to 5:00 PM in either CST or EST Monday - Friday. 8 hour days. Flexible start time between 7:30 and 8:30 AM to 4:00 PM and 5:00 PM.

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.

Job Function: Health Care