UM Nurse Consultant

Aetna Inc. Kent , WA 98031

Posted 5 days ago

Job Description:

The hours for this position are 11:30-8pm EST.

POSITION SUMMARY

This position is with American Health Holding, an Aetna company. The UM Nurse utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The hours for this position are 11:30-8PM ET.

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.

Qualification Requirements:

  • Minimum of 3-5 years clinical experience required.

  • Active, unrestricted Registered Nurse (RN) License required.

  • Utilization Management (UM) experience required.

  • Managed Care experience preferred.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

Functional

  • Clinical / Medical/Precertification/1-3 Years

Functional

  • Clinical / Medical/Concurrent review / discharge planning/1-3 Years

Functional

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

TECHNOLOGY EXPERIENCES

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

General Business/Applying Reasoned Judgment/ADVANCED

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Turning Data into Information/FOUNDATION

Telework Specifications:

Full-Time Telework (WAH) Considered for any US location; training period in the office required

ADDITIONAL JOB INFORMATION

If you want to have an active role in changing members lives for the better, American Health Holding offers you a great opportunity to realize your potential. Our approach continues to improve outcomes for members while providing savings on health care expenditures for our clients. This has enabled American Health to remain an industry frontrunner in medical management.

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.