UM Nurse Consultant

Aetna Inc. Tempe , AZ 85280

Posted 3 days ago

Job Description:

This exciting role will sit in the Blue Bell, PA office!

Telework open for candidates located in Compact states (AZ, FL, GA, MD, MO, TN, TX, UT, VA, AK, DE, IA, ID, ME, MT, ND, SC, SD, WI, CO, KY, MS, NC, NE, NM, OK, WV, WY).

Candidate preferably located within 45 minutes of an Aetna office.

POSITION SUMMARY

The UM Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

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, 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.

BACKGROUND/EXPERIENCE

  • 3-5+ years of clinical experience required

  • 2+ years of Med/Surg experience required

  • Unrestricted RN required

  • Managed Care experience preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

Functional

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

Functional

  • Nursing/Medical-Surgical Care/4-6+ Years

Functional

  • Nursing/Clinical coverage and policies/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

Technical

  • Desktop Tools/TE Microsoft Excel/1-3+ Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Benefits Management/Supporting Medical Practice/ADVANCED

DESIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Turning Data into Information/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

Telework Specifications:

Considered for current internal teleworkers Blue Bell, Pa

Option for telework will be evaluated after a certain period of employment

ADDITIONAL JOB INFORMATION

We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.

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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UM Nurse Consultant

Aetna Inc.