Aetna LPN - Prior Authorization Nurse (NV MCD) in Las Vegas, Nevada
Req ID: 42561BR
This is an office based role in Las Vegas, NV.
The Prior Auth Nurse (LPN or LVN) position facilitates the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. LPN/LVN with current unrestricted state licensure required.
Fundamental Components include but are not limited to:
Promotes/supports quality effectiveness of Healthcare Services and benefit utilization
-Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration
-Collects information to support the process of rendering appropriate medical necessity/benefit determinations
-Identifies members for referral opportunities to integrate with other products, services and/or programs
-Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations
-Position may include working on a telephone queue
-Typical office working environment with productivity and quality expectations.
-2 years managed care experience is required
-2 plus years clinical experience required LPN/LVN with unrestricted active NV license is required
-Computer literacy in order to navigate through internal/external computer systems, including Microsoft Word and Excel.
-Ability to effectively participate in a multi-disciplinary team including internal and external participants.
-Experience and knowledge required in clinical guidelines, systems and tools i.e., MCG, Interqual
-Broad-based medical and surgical background
-Behavioral Health experience is strongly preferred
-Knowledge of community resources and provider networks
-Familiarity with local health care delivery systems
-Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
-Effective communication skills, both verbal and written.
-Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
-Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
One of the following is required: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN)
Benefits Management/Maximizing Healthcare Quality
Finance/Managing Aetnas Risk
General Business/Maximizing Work Practices
Leadership/Collaborating for Results
Service/Providing Solutions to Constituent Needs
ADDITIONAL JOB INFORMATION
Aetna Better Health of Nevada is looking for people like you who value excellence, integrity, caring and innovation. As an employee, youll join a team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Nevada, and we will support you all the way.
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. We give special attention to vulnerable populations, and require a level of cultural competence from all employees in an effort to solve for the needs of Medicaid members and to connect special populations to the unique resources they need to live healthier lives. We prioritize member connections in response to each member s cultural values and preferences. 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.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Job Function: Health Care