Aetna UM Nurse Consultant in Charlottesville, Virginia

Req ID: 39108BR

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.

Telework may be considered in the future from a location close to an Aetna office.

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 desired:

Managed Care experience preferred

3-5 years of clinical experience required (hospital versus home health care)

Use of MCG (Milliman) criteria preferred

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

FUNCTIONAL EXPERIENCES

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

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Computer Operations/System and Console Operations/1-3 Years/End User

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

DESIRED SKILLS

General Business/Consulting for Solutions/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

Service/Providing Solutions to Constituent Needs/ADVANCED

Telework Specifications:

Work at home can be considered in the future but not guaranteed. All employees are subject to return to nearest office location if business needs change.

ADDITIONAL JOB INFORMATION

This job offers the use of nursing judgment and skills without working nights and weekends. The ability to work from home increases work-life balance.

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