Aetna UM Nurse Consultant in San Antonio, Texas

Req ID: 49567BR

POSITION SUMMARY

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted license

This is an In office position in San Antonio for Internal and External Candidates.

Fundamental Components:

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, and procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.

BACKGROUND/EXPERIENCE: Managed Care experience; Preferred3-5 years of clinical experience; Required Med-Surg or Outpatient Clinical Experience; PreferredProficiency with computer skills, navigating multiple systems and keyboarding; RequiredEffective communication skills, both verbal and written; Required

EDUCATION

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

LICENSES AND CERTIFICATIONS

Registered Nurse,RN (Texas- TX) ; Required

FUNCTIONAL EXPERIENCES

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

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

Functional - Nursing/Critical Care/1-3 Years

Functional - Nursing/Discharge Planning/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Exchange/1-3 Years/End User

Technical - Desktop Tools/Microsoft Explorer/1-3 Years/End User

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

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Supporting Medical Practice/ADVANCED

Telework Specifications:

Full-time office based position in San Antonio, TX ( All candidates Must live near the office location)

ADDITIONAL JOB INFORMATION

This position allows the RN to make significant impact to the healthcare of the people we serve. By working collaboratively with providers and co-workers the nurse is able to provide the right services at the right time and place for the right reason. It allows the RN an opportunity to grow, to increase his or her knowledge and truly advocate for the member.

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