Aetna UM Nurse Consultant in Richfield, Ohio
Req ID: 49562BR
This exciting opportunity will sit in the Richfield, OH office!
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.
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
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)
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 - Nursing/Medical-Surgical Care/1-3+ Years
Functional - Nursing/Discharge Planning/1-3+ Years
Functional - Nursing/Concurrent Review/discharge planning/1-3+ Years
Technical - Desktop Tools/Microsoft Word/1-3+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3+ Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Supporting Medical Practice/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
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