Aetna Utilization Management Nurse Consultant (RN)- Registered Nurse in San Bernardino, California

Req ID: 43278BR

Position open to all CA offices and open to telework. POSITION SUMMARY

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program within the HealthCare Vertical Team. Requires an RN with unrestricted active license.Requires an RN with unrestricted active license and may require some weekend hours or rotation of hours to accommodate business needs.

Fundamental components include, but are not limited to:

  • Reviewing services to assure medical necessity.

  • Applying clinical expertise to assure appropriate benefit utilization.

  • Facilitating safe and efficient discharge planning.

  • Working closely with facilities and providers to meet the complex needs of the member.

    Qualification Requirements:

  • Minimum of 3-5 years of clinical experience required

  • RN License active in state of NY required

  • Ability to work nights and weekends per business needs

    Preferred Skills & Experience:

  • Med/Surge background, ICU & Telemetry experience HIGHLY preferred

  • Managed care experience preferred

  • Benefits management experience preferred

  • CCM (Certified Case Manager) preferred

    Education:

    The minimum level of education preferred for candidates in this position is a Bachelor's degree or equivalent experience.

    Licenses & Certifications:

  • Nursing License (RN) is required.

  • Certified Case Manager (CCM) is preferred.

    FUNCTIONAL EXPERIENCES

    Functional - Nursing/Clinical coverage and policies/1-3 Years

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

    TECHNOLOGY EXPERIENCES

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

    REQUIRED SKILLS

    Benefits Management/Interacting with Medical Professionals/ADVANCED

    Benefits Management/Maximizing Healthcare Quality/FOUNDATION

    Leadership/Collaborating for Results/ADVANCED

    DESIRED SKILLS

    Benefits Management/Supporting Medical Practice/ADVANCED

    Leadership/Driving a Culture of Compliance/FOUNDATION

    Service/Providing Solutions to Constituent Needs/ADVANCED

    ADDITIONAL JOB INFORMATION

    We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

    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