Aetna UM Clinical Consultant in Downers Grove, Illinois
Req ID: 37923BR
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.
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.
3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
Managed care/utilization review experience preferred
The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Nursing License is required
ADDITIONAL JOB INFORMATION
Supportive work environment, working closely with Medical Directors and other clinical teams
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.
Exciting opportunities at Aetna a leader within the Healthcare industry We are having an onsite Career/Job Fair seeking RN, LPN, LPC, LCSW and more Recruiters and hiring managers will be available for onsite interviews We will be at Palmer House Hilton17 East Monroe Chicago, ILJanuary 24, 2017 from 10a to 5p Doubletree Chicago800m National Parkway Schaumburg, ILJanuary 26, 2017 from 10a to 5p Please share and pass along this grand opportunity Remember, you can always visit our website for open opportunities
Job Function: Health Care