Aetna Registered Nurse (RN) Utilization Management (UM) Nurse Consultant - Full-Time Telework in Birmingham, Alabama
Req ID: 57136BR
This position is with American Health Holding/Aetna, a CVS Health company. The UM Nurse utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The hours for this position are 11:30AM-8PM ET. Position supports a clinical call center environment with requirement of occasional weekends.
This is a full-time telework (work at home) position following a required two-week on-site training in New Albany, OH upon hire.
Fundamental components include but are not limited to:
Utilizes 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.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.
Communicates with providers and other parties to facilitate care/treatment.
Identifies members for referral opportunities to integrate with other products, services and/or programs.
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.
Qualification Requirements and Preferences:
-Active, unrestricted Registered Nurse (RN) License required
-Utilization Management (UM) experience required
-3+ years of clinical experience required
-Managed Care experience preferred
-Exemplary clinical documentation skills; critical thinking skills
-Must be able to demonstrate computer proficiency skills and work independently as a self starter in a fast paced production and metrics driven environment
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Registered Nurse (RN) Licensure is required
Functional - Clinical / Medical/Precertification/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Nursing/Medical-Surgical Care/4-6 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
General Business/Turning Data into Information/FOUNDATION
Full-Time Telework (WAH) *Considered for any US location; training period in the office is required.
ADDITIONAL JOB INFORMATION
If you want to have an active role in changing members lives for the better, American Health Holding offers you a great opportunity to realize your potential. Our approach continues to improve outcomes for members while providing savings on health care expenditures for our clients. This has enabled American Health to remain an industry frontrunner in medical management.
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.