Aetna Utilization Management Nurse Consultant RN in Blue Bell, Pennsylvania
Req ID: 52715BR
The UM Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company
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 membersGathers 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 function
Managed Care experience preferred 3-5 years of clinical experience required Excellent verbal and written communication skills
The highest level of education preferred for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/RN Nursing License is required
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Functional - Nursing/Medical-Surgical Care/4-6 Years
Functional - Nursing/Disease management/1-3 Years
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
General Business/Applying Reasoned Judgment/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Turning Data into Information/FOUNDATION
ADDITIONAL JOB INFORMATION
This is a challenging position that allows you to utilize your clinical skills to have a positive impact on member health opportunities.
Position hours 9-530 Saturday and Holiday rotation
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