Aetna Registered Nurse (RN) - Utilization Management (UM) Nurse Consultant in High Point, North Carolina
Req ID: 38151BR
As a Registered Nurse (RN) Utilization Management 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.
Ability to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills. This position is in an office environment using a computer station and may require sitting for extended periods of time. Candidate must possess good computer skills. This is a quick paced position that requires timeliness standards are met. All patient/provider contact is via phone or electronic media. Full Time positions with flexible hours, M-F. 2-3 times a month until 9:00pm ET is required.
High Point is within commuting distance to Greensboro, Winston Salem and Kenersville, NC!
Fundamental Components of the UM Nurse Consultant role include, but are not limited to:
Gathers clinical information and applies the appropriate policy, procedure and clinical judgment to render coverage 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 Lends expertise to other internal and external constituents in the coordination and administration of the utilization management / benefit management function
Minimum of 4-6 years clinical experience required.
Managed Care experience is a plus.
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is desired
Functional - Nursing/Concurrent Review/discharge planning/4-6 Years
Technical - Operating Systems/Windows/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Supporting Medical Practice/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Benefits Management/Maximizing Healthcare Quality/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