Aetna Utilization Management Clinical Consultant (RN) in Allentown, Pennsylvania
Req ID: 55894BR
Required hours are 8am-5pm EST. The regular schedule will include working Saturdays and Sundays and 3 days during the week.
This is a telework role. External applicants to Aetna will need to reside in Pennsylvania.
Concurrent Review Nurse will work within the Utilization Management team to review clinical for inpatient hospitalizations and rehabilitation post hospitalization. Will send necessary referrals to other departments.
Fundamental components include but are not limited to:
-Concurrent Review Nurse will work within the UM team to review hospitalizations and rehabilitation post hospitalization in a Medicaid population.
-Works closely with Medical Directors and Case Management to fulfill the needs of our members and providers.
-Reviews clinical against specialized criteria
An RN license is required
-3-5 years clinical practice experience is required
-Managed care/utilization review experience preferred.
-Must be willing to work weekends
-Good computer skills required
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Functional - Nursing/Medical-Surgical Care/4-6 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Full Time Telework (WAH)
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.
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.