Aetna UM Nurse Consultant in Downers Grove, Illinois
Req ID: 39200BR
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Requires an RN with unrestricted active license.
Downers Grove location
Weekend rotation Saturday and Sunday
Ability to multitask/prioritize workload/attend CMO rounds/adapt to fast paced environment
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
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
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 (RN) is required
ADDITIONAL JOB INFORMATION
Exposure to various clinical reviews
Joining a team of highly motivated clinicians
Exposure to multidisciplinary rounds
Avenues for internal growth/leadership opportunities
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.
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Job Function: Health Care