Aetna UM Nurse Consultant in Columbus, Indiana

Req ID: 43649BR

Open to any Aetna Office in the Great Lakes region: WI, MI, MN, IN and IL.

Potential Work at Home opportunities.

POSITION SUMMARY

As a UM Nurse consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.

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:

RN licensure required 3-5 years of clinical experience required Managed Care experience 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/Clinical claim review and coding/1-3 Years

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

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

Functional - Nursing/Legal and benefit interpretation/1-3 Years

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Consulting for Solutions/FOUNDATION

DESIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

General Business/Turning Data into Information/FOUNDATION

Service/Providing Solutions to Constituent Needs/ADVANCED

Telework Specifications:

Considered only for locations in a specific region, state, or city; training period in the office may be required

This posting is for ACUTE & SUB ACUTE for GL markets which could include IL, MI, MN, WI or IN

ADDITIONAL JOB INFORMATION

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