Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.
Requires an RN with unrestricted active license.
This will be a full-time telework position.
Schedule is Monday-Friday, standard business hours.
Candidates must be located in VA, MD, OH, PA, or Washington D.C.
Aetna is an Equal Opportunity, Affirmative Action Employer
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, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care.
Communicates with providers and other parties to facilitate care/treatment.
Identifies members for referral opportunities to integrate with other products, services, and/or programs.
Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
3+ years of clinical experience required
RN with current unrestricted state licensure required
Post-acute experience preferred
Managed care experience preferred
Utilization management experience preferred
Benefit eligibility may vary by position.
Candidate Privacy Information
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.