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Aetna Prior Authorization Nurse LPN/LVN Texas Star Kids in Dallas, Texas

Req ID: 71040BR

Job Description

At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of Texas STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

This position will be working out of the 2777 Stemmons Freeway location in Dallas TX.

At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you ll join a team dedicated to improving the lives of Texas STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.

Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Requires LPN/LVN with unrestricted active license.

Fundamental Components included but are not limited to:

Promotes/supports quality effectiveness of Healthcare Services and benefit utilization Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration Collects information to support the process of rendering appropriate medical necessity/benefit determinations Identifies members for referral opportunities to integrate with other products, services and/or programs Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations

Qualifications Requirements and Preferences:

  • 3+ years clinical experience required. (Required)

  • LPN/LVN with current unrestricted state licensure required. (Required)

  • 2+ years managed care experience. (Preferred)

  • Pediatric/Adolescent experience preferred

  • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.

  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

  • Effective communication skills, both verbal and written.

  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required.

  • Ability to effectively participate in a multi-disciplinary team including internal and external participants

  • Typical office working environment with productivity and quality expectations.

  • Work requires the ability to perform close inspection of handwritten and computer- generated documents as well as a PC monitor.

  • Sedentary work involving periods of sitting, talking, listening.

  • Work requires sitting for extended periods, talking on the telephone and typing on the computer.

Additional Job Information:

Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Benefit Eligibility

Benefit eligibility may vary by 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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