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Registered Nurse (RN) - UM Nurse Consultant - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | High Point, North Carolina |
About this job
This position supports American Health Holding (AHH). Telecommuters must have a separate dedicated area for HIPAA compliance.
The hours for these positions are 11:30 AM and ending at 8:00 PM ET.
This position is work at home from any location
Minimum internet requirements for a telecommuting position include:
* A separate wired Internet connection
* Minimum download speed of 6MB
* Minimum upload speed of 1MB
* Satellite and other wireless Internet are NOT supported
POSITION SUMMARY
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Requires an RN with unrestricted active license.
- Requires at least fives years acute hospital care.
- Clinical is processed against approved criteria.
- All aspects of the utilization process (including precertification, concurrent and retro reviews and discharge planning) require adherence to URAC standards, various laws and regulations and company policies and procedures.
- The UM nurse consultant needs to be highly organized, effective in time management, ability to manage multiple priorities, have strong teamwork skills, comfortable having his/her work measured, and have strong keyboard and telephone skills.
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 (RN) is required
REQUIRED FUNCTIONAL EXPERIENCES
Nursing/Medical-Surgical Care/Clinical Experience/3+ Years Required
Utilization Review/Utilization Management/1+ Years Required
REQUIRED SKILLS
Technology/Leveraging Technology
General Business/Turning Data into Information
Benefits Management/Interacting with Medical Professionals
DESIRED SKILLS
Benefits Management/Maximizing Healthcare Quality
ADDITIONAL JOB 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.
Employment Type Regular Career Band Description Professional
The hours for these positions are 11:30 AM and ending at 8:00 PM ET.
This position is work at home from any location
Minimum internet requirements for a telecommuting position include:
* A separate wired Internet connection
* Minimum download speed of 6MB
* Minimum upload speed of 1MB
* Satellite and other wireless Internet are NOT supported
POSITION SUMMARY
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Requires an RN with unrestricted active license.
- Requires at least fives years acute hospital care.
- Clinical is processed against approved criteria.
- All aspects of the utilization process (including precertification, concurrent and retro reviews and discharge planning) require adherence to URAC standards, various laws and regulations and company policies and procedures.
- The UM nurse consultant needs to be highly organized, effective in time management, ability to manage multiple priorities, have strong teamwork skills, comfortable having his/her work measured, and have strong keyboard and telephone skills.
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 (RN) is required
REQUIRED FUNCTIONAL EXPERIENCES
Nursing/Medical-Surgical Care/Clinical Experience/3+ Years Required
Utilization Review/Utilization Management/1+ Years Required
REQUIRED SKILLS
Technology/Leveraging Technology
General Business/Turning Data into Information
Benefits Management/Interacting with Medical Professionals
DESIRED SKILLS
Benefits Management/Maximizing Healthcare Quality
ADDITIONAL JOB 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.
Employment Type Regular Career Band Description Professional