Aetna Utilization Management Nurse (RN) Consultant in Chicago, Illinois

Req ID: 56190BR

POSITION SUMMARY

The clinician will respond to providers and members timely in reviewing medical necessity of the requested services. The clinician will collaborate with other departments, vendor partners, and community liaisons to assist our members with health needs or concerns.

Hours are Monday-Friday. Rotating weekends 4-5 weeks. Daily hours are 8am-5pm. No nights. Holidays are rotating and occasional.

Fundamental Components but not limited to the following:

The focus of the job is to conduct medical necessity reviews of various requests/services of our members. It includes application of the right clinical guidelines along with compliance to CMS/Medicare guidelines. The clinician will work with providers so appropriate information is submitted and reviewed timely. The clinician will also work closely with Case Management so the members' needs are addressed timely and appropriately. Proficiency with use of various search engines and computer are needed for this role.

BACKGROUND/EXPERIENCE:

Managed Care experience preferred

3+ years of clinical RN experience required in behavioral health

Proficiency with use of a computer and search engine

EDUCATION

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 License is required unrestricted, active for the State of Illinois

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

ADDITIONAL JOB INFORMATION

Ability to apply clinical knowledge, work with other clinicians of various specialties, clinical rounds with the CMO, and work with various hospitals in Illinois

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.