UM Nurse Associate

Aetna Inc. Richmond , VA 23234

Posted 2 weeks ago

Job Description:

POSITION SUMMARY

The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.

Standard business hours and no nights and no holidays.

Fundamental Components but not limited to the following:

Promotes/supports quality effectiveness of Healthcare Services and benefit utilization Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration Collects information to support the process of rendering appropriate medical necessity/benefit determinations Identifies members for referral opportunities to integrate with other products, services and/or programs Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations.

BACKGROUND/EXPERIENCE:
2 years managed care experience preferred
2 years clinical experience required

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Licensed Practical Nurse (LPN) is required active and unrestricted

FUNCTIONAL EXPERIENCES

Functional

  • Clinical / Medical/Disease management/1 Year

Functional

  • Clinical / Medical/Precertification/1 Year

Functional

  • Medical Management/Medical Management

  • Hospital/1 Year

Telework Specifications:

After trained and fully competent, we will allow telework once a week

ADDITIONAL JOB INFORMATION

To be a part of a Fortune 500 company with the flexibility to grow in your professional career.

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 candidates'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.



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