Aetna UM Nurse Consultant in Parsippany, New Jersey

Req ID: 43617BR

This position is open to candidates in New York or New Jersey. If you live near an Aetna office, you would report to the nearest office. The hours of operation are 8:00 am to 9:00 pm EST. It does requires an evening shift rotation to 9:00 pm 1-2 times per month including weekends.

POSITION SUMMARY:

In this Utilization Management Consultant position you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.

Fundamental Components include, but are not limited to:

Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support) Identifies members who may benefit from care management programs and facilitates referral 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:

-3-5 years of clinical experience required e.g., hospital setting, rehab, skilled nursing, alternative care setting such as home health or ambulatory care required

-Medicare guidelines experience preferred

-Managed Care experience preferred

-Registered nurse (RN) with unrestricted state license is required.

-Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

EDUCATION:

-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 desired

FUNCTIONAL EXPERIENCES:

Functional - Nursing/Discharge Planning/1-3 Years

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

Functional - Nursing/Home Health Care Ambulatory Nursing/1-3 Years

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

Functional - Nursing/Critical Care/1-3 Years

TECHNOLOGY EXPERIENCES:

Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

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

REQUIRED SKILLS:

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Turning Data into Information/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS:

Benefits Management/Supporting Medical Practice/ADVANCED

General Business/Consulting for Solutions/FOUNDATION

Benefits Management/Interacting with Medical Professionals/ADVANCED

ADDITIONAL JOB INFORMATION

Work telephonically supported by a high functioning team.

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.

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