Aetna UM Nurse Consultant in Denver, Colorado

Req ID: 38197BR

Hours are anywhere from 7am - 6pm 8 hour shift

POSITION SUMMARY

Telephonic Utilization Review nurse with RN degree. Ability to multi-task between telephonic reviews and data entry of clinical information.

Fundamental Components:

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.

BACKGROUND/EXPERIENCE desired:

Managed Care experience preferred

3-5 years of clinical experience required

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 is required

FUNCTIONAL EXPERIENCES

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

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

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