Aetna UM Nurse Consultant in Denver, Colorado
Req ID: 38197BR
Hours are anywhere from 7am - 6pm 8 hour shift
Telephonic Utilization Review nurse with RN degree. Ability to multi-task between telephonic reviews and data entry of clinical information.
Perform Medical Necessity review for services requiring preauthorization. These services include but are not limited: to Inpatient, DME, Procedures, OP, IV infusion, Medications, Rehab, Skilled Nursing Facility, Substance abuse, IP and OP Mental Health. Issue notification of determination decisions related to concurrent review determinations. This includes communications to provider, hospital and Member. Meet specific job metrics related to audits scores and daily production.
Managed Care experience preferred
3-5 years of clinical experience required
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 is required
Functional - Nursing/Discharge Planning/1-3 Years
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Functional - Nursing/Clinical coverage and policies/1-3 Years
Functional - Nursing/Medical-Surgical Care/1-3 Years
Technical - Desktop Tools/Microsoft Exchange/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
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.
Job Function: Health Care