Aetna UM Nurse Consultant in Richfield, Ohio

Req ID: 49562BR

This exciting opportunity will sit in the Richfield, OH office!

POSITION SUMMARY

The UM Nurse Consultant role entails the nurse to utilize clinical judgment along with criteria/guidelines to ensure the member is in the appropriate setting. The inpatient care process includes obtaining necessary information from providers and facilities concerning the care being provided to members.

Fundamental Components:

Completing assessments of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness 90% of the day is spent utilizing clinical judgment along with criteria to ensure the member is in the appropriate setting Guide the setting for medical intervention to achieve optimum length of stay for members Early identification of continuing care needs to facilitate discharge to the appropriate setting and discharge planning Collaborate with other team members to ensure the member's discharge plan is met and discuss other issues or needs

BACKGROUND/EXPERIENCE

Unrestricted RN Licensure (Required)3-5+ years of clinical experience (Required)2+ years utilization review and/ or discharge planning experience (Preferred)Managed Care experience (Preferred)Excellent verbal and written communication skills (Required)Strong computer skills (Microsoft Outlook, Word, Window Systems) (Required)

EDUCATION

The highest level of education desired for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is Required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/1-3+ Years

Functional - Nursing/Discharge Planning/1-3+ Years

Functional - Nursing/Concurrent Review/discharge planning/1-3+ Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Word/1-3+ Years/End User

Technical - Desktop Tools/Microsoft Outlook/1-3+ Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Supporting Medical Practice/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Turning Data into Information/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

ADDITIONAL JOB INFORMATION

Work with a very collaborative team - Potential for growth and development

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