Registered Nurse (RN) - Utilization Management (UM) Nurse Consultant

This is a full-time, in-office position based out of our Arlington, TX office. Internal candidates currently WAH/telework may be considered, but remaining WAH/telework will be evaluated on a case by case basis. Prior experience in utilization management and specifically using Milliman Care guidelines is highly preferred.

POSITION SUMMARY

The Utilization Management Nurse Consultant works to facilitate the delivery of appropriate benefits and/or healthcare. He/She will develop, implement and support Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness.

Fundamental Components:

The Utilization Management Nurse Consultant duties include, but are not limited to, the following:

1. Utilization of 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.

2. Gather clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care.

3. Communication with providers and other parties to facilitate care/treatment.

4. Identification of members for referral opportunities to integrate with other products, services and/or programs.

5. Identification of opportunities to promote quality effectiveness of Healthcare Services and benefit utilization.

6. Consultation and collaboration that lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

BACKGROUND/EXPERIENCE desired:

Managed Care experience preferred, 3-5 years of clinical experience required. Strong, effective verbal and written communication skills. Effective Organization skills. Efficient computer skills. Utilization Management experience highly preferred.

EDUCATION

The level of education desired for candidates in this position is at least an Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Medical-Surgical Care/1-3 Years

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

Functional - Medical Management/Medical Management - Managed Care/Insurance Clinical Staff/1-3 Years

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 Explorer/1-3 Years/End User

REQUIRED SKILLS

General Business/Applying Reasoned Judgment/ADVANCED

Leadership/Collaborating for Results/ADVANCED

Benefits Management/Interacting with Medical Professionals/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Service/Providing Solutions to Constituent Needs/ADVANCED

Telework Specifications:

Option for telework will be evaluated after a certain period of employment.

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.

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 Professional