Aetna Utilization Management Nurse in High Point, North Carolina
Req ID: 49119BR
This role is in our High Point, NC office.
As an Utilization Nurse Consultant you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Looking for someone who enjoys working in an office in a high energy and motivated team environment and is detail oriented and highly organized. This role is located in the High Point, NC office and will require being in the office at least the first 12-18 months. This is a dynamic and passionate team, with much support!
This position is in an office environment using a computer station and may require sitting for extended periods of time. - Candidate must possess computer and typing skills. - This is ideal for an applicant seeking a fast paced environment. Full Time positions with business hours, Monday through Friday. To service west coast customers, nurses will be required to work 2-3 times a month until 9:00pm EST after training. Saturday work required after 6 months of training, 1-2 Saturdays per quarter can be expected, to meet federal and state regulated turn-around times. The office is located at 4050 Piedmont Parkway, High Point, NC. Work from home opportunities may be available after 12-18 months of employment, determined by business need.
Additional Job Responsibilties:
Gathers clinical information and applies the appropriate policy, procedure and clinical judgment to render coverage recommendation along the continuum of careBegins proactive discharge planning to facilitate safe and effective transitions to the next level of care, such as home or alternate discharge locationCommunicates with providers and other parties to facilitate care/treatment, demonstrating superior customer service skillsIdentifies members for referral opportunities to integrate with other products, services and/or programsIdentifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilizationLends expertise to other internal and external constituents in the coordination and administration of the utilization management / benefit management functionThis is a quick paced position that requires timeliness standards are metAll patient/provider contact is via phone or electronic mediaBackground/Experience:
Minimum of 2 years of clinical experience required (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more!) RN required, unrestricted Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skillsAbility to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skillsAbility to manage multiple priorities, effective organizational and time management skillsThis position is in an office environment using a computer station and may require sitting for extended periods of timeAny managed care background is a plusUtilization Review experience preferred but not requiredEducation:
The minimum level of education required for candidates in this position is a Associate's degreeLicenses and Certifications:
Registered Nurse (RN) with active state license in good standing requiredFunctional Experiences:
Functional - Nursing/Concurrent Review/discharge planning/1+ YearsTechnology Experiences:
Technical - Operating Systems/Windows/1+ Years/End UserRequired Skills:
Benefits Management/Interacting with Medical Professionals/3+ years/ADVANCEDBenefits Management/Maximizing Healthcare Quality/1+ years/FOUNDATIONGeneral Business/Applying Reasoned Judgment/3+ years/ADVANCED Telework Specifications:
Work from home opportunities may be available after 12-18 months of employment, determined by business need.
Additional Job Information:
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