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Req ID: 57171BR

POSITION SUMMARY

This is an office-based position in Allentown, PA. Please note, the office will be relocating to Bethlehem, PA in April 2019.

As an Utilization Nurse Consultant you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written and electronic clinical records. Looking for someone who enjoys working in an office on a motivated team and is detail oriented and highly organized.

Fundamental Components:

The UMNC utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient and outpatient healthcare management. Proactive discharge planning obtains the necessary information from providers and facilities concerning the care being provided to determine medical appropriateness optimum length of stay for members early identification of continuing care needs and communicates these needs with our case managers and medical director as necessary

BACKGROUND/EXPERIENCE:

RN licensure required

3+ years clinical experience required

UM/UR experience preferred

Managed care experience preferred

Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills

Ability to manage multiple priorities, effective organizational and time management skills

Ability to exercise independent and sound critical thinking, strong decision-making skills and well-developed interpersonal skills

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Concurrent Review/discharge planning/4+ Years

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

TECHNOLOGY EXPERIENCES

Technical - Operating Systems/Windows/4+ Years/End User

REQUIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED

Telework Specifications:

Work from home opportunities may be an option after 18 months, if business needs allow. Internals that are currently WAH may apply but adhere to the schedule listed above on eastern time.

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

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 candidates'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

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.