Aetna Utilization Management Nurse (RN) Consultant in Chicago, Illinois
Req ID: 56190BR
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.
Managed Care experience preferred
3+ years of clinical RN experience required in behavioral health
Proficiency with use of a computer and search engine
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
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.
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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.