Utilization Management Nurse Consultant - Registered Nurse

Aetna Inc. Hartford , CT 06183

Posted 1 week ago

Job Description:

POSITION SUMMARY

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Collaborates with team for improved outcomes. Requires an RN with unrestricted active license and may require some weekend hours or rotation of hours to accommodate business needs.

Fundamental Components:

Reviewing services to assure medical necessity

Applying clinical expertise to assure appropriate benefit utilization

Facilitate safe and efficient discharge planning

Work closely with facilities and providers to meet the complex needs of the member

Applying clinical expertise to assure appropriate benefit utilization

Multitasker that can prioritize their tasks for the day and be flexible and adjust when members needs change.

BACKGROUND/EXPERIENCE:

Managed Care experience preferred
3+ years of clinical experience required
1+ years of Concurrent review/Discharge planning experience preferred
1+ years of pre-certification experience preferred

RN License required

Certified Case Manager certification preferred

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Certified Case Manager is preferred

Nursing/Registered Nurse (RN) is required

FUNCTIONAL EXPERIENCES

Functional

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

Functional

  • Nursing/Clinical coverage and policies/1-3 Years

Functional

  • Nursing/Discharge Planning/1-3 Years

TECHNOLOGY EXPERIENCES

Technical

  • Desktop Tools/Microsoft Word/4-6 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

Benefits Management/Interacting with Medical Professionals/ADVANCED

Technology/Leveraging Technology/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

General Business/Consulting for Solutions/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

ADDITIONAL JOB INFORMATION

Requires unrestricted RN License

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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Utilization Management Nurse Consultant - Registered Nurse

Aetna Inc.