Aetna UM Nurse Consultant in New Albany, Ohio

Req ID: 37731BR

POSITION SUMMARY

This position is with American Health Holding, an Aetna Company. The UM Nurse utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The hours for this position are 11:30-8PM ET or 12:30-9 PMET

Fundamental Components:

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 Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

BACKGROUND/EXPERIENCE desired:

An active, unrestricted RN license irequired.

Utilization Management experience required

3-5 years of clinical experience required.

Managed Care experience preferred.

EDUCATION

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 required

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Precertification/1-3 Years

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

Functional - Nursing/Medical-Surgical Care/4-6 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Turning Data into Information/FOUNDATION

Telework Specifications:

Full-Time Telework (WAH)

Considered for any US location; training period in the office may be required.

ADDITIONAL JOB INFORMATION

If you want to have an active role in changing members lives for the better, American Health Holding offers you a great opportunity to realize your potential. Our approach continues to improve outcomes for members while providing savings on health care expenditures for our clients. This has enabled American Health to remain an industry frontrunner in medical management.

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.

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.

Job Function: Health Care