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Aetna Utilization Management Nurse Consultant in Bethlehem, Pennsylvania

Req ID: 61389BR

Job Description

This is an in-office position in the Bethlehem, PA office. Telework will be considered for current internal teleworkers only.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.

Fundamental Components included but are not limited to:

We are looking for a Utilization Management Nurse Consultant to join the Bethlehem, Pennsylvania, Public and Labor Unit. In the Utilization Management Nurse Consultant role we are looking for a candidate who will be able to utilize 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.

The UMNC will gather clinical information and apply the appropriate clinical criteria, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. The UMNC communicates with providers and other parties to facilitate care/treatment and lends expertise to other internal and external constituents in the coordination and administration of the utilization management function.

UMNC will work collaboratively with the other members of the care advocate team. Requires an RN with unrestricted active license. Minimum 3 years of recent experience. Must possess strong verbal, written communication skills, computer and keyboarding skills.

Qualifications Requirements and Preferences:

3+ years of clinical experience required

RN with current unrestricted state licensure required.

Managed Care experience preferred

Licenses/Certifications:

Nursing - Registered Nurse

Functional Skills:

Nursing - Clinical coverage and policies, Nursing - Concurrent Review/discharge planning, Nursing - Critical Care, Nursing - Medical-Surgical Care

Technology Experience:

Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows

Required Skills:

Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice

Desired Skills:

General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Service - Providing Solutions to Constituent Needs

Additional Job Information:

The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred. Candidate must possess good computer skills. Hours of operation are 8:00 AM to 8:00 PM EST Monday - Friday. Evening Shift rotation (11:30 AM- 8:00 PM) 1-2 times a month.

Benefit Eligibility

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Job Function: Healthcare

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.

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