Utilization Management Nurse Consultant

This is an office based role in New Albany, OH. Current Aetna teleworkers may remain work at home.
Aetna One Advocate is a team of clinical and service professionals dedicated and empowered to take care of all aspects of a members health. Utilization Management Nurse Consultants utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Fundamental components include but are not limited to:
The Utilization Management Nurse Consultant candidate will be able to utilize 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. The UMNC will gather clinical information and apply the appropriate clinical criteria, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. The UMNC communicates with providers and other parties to facilitate care/treatment and lends expertise to other internal and external constituents in the coordination and administration of the utilization management function. The UMNC will integrate and collaborate with the other members of the Aetna One Advocacy team to support the single point of contact design for the member and enrolled family. Assist with effective use of health care benefits, access to available programs/services and determining next best actions to achieve health ambitions.
Requires an RN with unrestricted active license. Minimum 3 to 5 years of recent experience. Must possess strong verbal, written communication skills, computer and keyboarding skills.
Managed Care experience preferred
3-5 years of clinical experience required
RN with current, unrestricted licensure in state in which work is being done required
Willingness to obtain RN licensure in other states as needed
BSN or equivalent experience required
The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
Registered Nurse is required
Concurrent Review/discharge planning/1-3 Years
Medical-Surgical Care/4-6 Years
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Aetna Applications/Aetna Strategic Desktop Reporting/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/ADVANCED
Telework Specifications:
Option for telework will be evaluated after a certain period of employment
Existing internal applicants who are telework may remain telework
Demonstrates highly developed communication and people skills. Ability to engage and interact easily with diverse group of individuals. Strong listener, empathetic and supporting.
Ability to prioritize and multitask in fast paced, deadline driven environment.
Ability to adapt to constantly changing demands and environment.
Demonstrates a commitment to service; accountable for actions and issues resolution, responsive to customer needs.
Team player collaborates with co-workers and vendor partners to deliver best in class service.
Demonstrates strong problem solving skills and ability to work independently.
Requires proficiency with computer skills including keyboarding, navigating multiple systems.
Proficiency in use of Microsoft Outlook and Office.
Must be able to work in office setting with extended periods of time sitting, talking on telephone and typing on computer.
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 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.
Employment Type Regular Career Band Description Professional

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