Aetna Utilization Management UM Nurse Consultant (RN) in Ft. Lauderdale, Florida
Req ID: 67556BR
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Schedule is Monday-Friday. Possibility of one weekend per month on call after trained. No nights.
Onsite role in Plantation, FL.
Fundamental Components included 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 function
Qualifications Requirements and Preferences:
3 years of clinical experience required (acute care, home health)
Seeking care management and claims experience
Managed Care experience preferred
Utilization management or concurrent review experience
RN with current unrestricted Florida state licensure required.
Nursing - Registered Nurse (RN)
Clinical / Medical - Direct patient care (hospital, private practice)
Additional Job Information:
Typical office working environment with productivity and quality expectations Work 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 environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written.
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.