UM Nurse Consultant

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.

Fundamental Components:

* Utilizes 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

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

* Communicates with providers and other parties to facilitate care/treatment

* Identifies members for referral opportunities to integrate with other products, services and/or programs

* Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization

* Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

BACKGROUND/EXPERIENCE desired:

RN required

3+ years of clinical experience required

Basic computer skills; typing skills are a must

Managed Care experience preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Board of Nursing (Any State) is required

FUNCTIONAL EXPERIENCES

Functional - Medical Management/Medical Management - Clinical claim review/1+Years

Functional - Nursing/Clinical coverage and policies/1+Years

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

Functional - Nursing/Legal and benefit interpretation/1+Years

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Finance/Managing Aetnas Risk/FOUNDATION

General Business/Applying Reasoned Judgment/ADVANCED

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.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Employment Type Regular Career Band Description Professional