Aetna Utilization Management Nurse Consultant in New Albany, Ohio
Req ID: 48691BR
This role is office based in New Albany, OH
The hours are Monday-Friday 8am-5pm EST with the requirement of working occasional and rotating weekends and holidays.
The UM Nurse Consultant reviews inpatient cases for medical necessity. Levels of care that are reviewed include acute inpatient hospital, LTACH (long term acute care), Acute Inpatient Rehab, and SNF (skilled nursing facility). Criteria utilized includes MCG and the Medicare Benefits manual. The UM nurse consultant collaborates closely with care managers and the medical directors.
Fundamental components include but are not limited to:
-Telephonic utilization review of inpatient cases
-Reviews inpatient cases for medical necessity
-Utilizes MCG and the Medicare Benefits Manual for criteria
-Close collaboration with care managers and the medical directors
-Rewarding position obtaining care that our members need
-Close team environment
An RN license is required
Managed Care experience preferred
3-5 years of clinical experience required
1 year minimum experience with adult population in hospital setting is required
Must work well independently and also in a group setting
Must be able to type with both hands
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Managed Care/Managed Healthcare Professional is desired
Nursing/Registered Nurse is required
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Technical - Hardware/PCs/1-3 Years/End User
Technical - Aetna Applications/QNXT/1-3 Years/End User
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
Option for telework will be evaluated after a certain period of employment
Team may be eligible for full time telework in the future
ADDITIONAL JOB INFORMATION
Once the employee is trained, proficient, and meeting expectations then part time work at home is permitted. There is some flexibility in the work hours once the employee is trained, proficient, and meeting expectations.
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 candidate'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