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Registered Nurse (RN) / LPN - Utilization Management (UM) Nurse Associate - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Phoenix, Arizona |
About this job
POSITION SUMMARY
As a Utilization Management (UM) Nurse Consultant, you will utilize clinical skills to support the coordination, documentation and communication of the Prior Authorization benefit program for Medicare/Medicaid populations. On a daily basis, you will apply critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate prior authorization of services.
Fundamental Components of the UM Nurse Associate role include, but are not limited to:
- Performs medical necessity reviews for requests requiring prior authorization
- Presents clear and accurate documentation that demonstrates proper application of clinical criteria
- Collaborates with staff to ensure timely and accurate processing of authorization request
BACKGROUND/EXPERIENCE desired:
- 3-5 years clinical practice experience is required
- Managed care/Prior Authorization experience preferred
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Licensed Practical Nurse (LPN) OR Registered Nurse (RN) license is required to be considered for this role.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
TELEWORK SPECIFICATIONS
This position will be an in-office role in Phoenix, AZ. However, there will be a potential to work at home after 6-12 months of training and proven performance. However, this is never a guarantee.
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
ADDITIONAL COMPANY INFORMATION
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Business Support & Technical
As a Utilization Management (UM) Nurse Consultant, you will utilize clinical skills to support the coordination, documentation and communication of the Prior Authorization benefit program for Medicare/Medicaid populations. On a daily basis, you will apply critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate prior authorization of services.
Fundamental Components of the UM Nurse Associate role include, but are not limited to:
- Performs medical necessity reviews for requests requiring prior authorization
- Presents clear and accurate documentation that demonstrates proper application of clinical criteria
- Collaborates with staff to ensure timely and accurate processing of authorization request
BACKGROUND/EXPERIENCE desired:
- 3-5 years clinical practice experience is required
- Managed care/Prior Authorization experience preferred
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Licensed Practical Nurse (LPN) OR Registered Nurse (RN) license is required to be considered for this role.
FUNCTIONAL EXPERIENCES
Functional - Clinical / Medical/Clinical claim review & coding/1-3 Years
Functional - Nursing/Medical-Surgical Care/1-3 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
TELEWORK SPECIFICATIONS
This position will be an in-office role in Phoenix, AZ. However, there will be a potential to work at home after 6-12 months of training and proven performance. However, this is never a guarantee.
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft SharePoint/1-3 Years/End User
ADDITIONAL COMPANY INFORMATION
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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Employment Type Regular Career Band Description Business Support & Technical
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