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UM Nurse Consultant
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Sunrise, FL Sunrise, Florida |
About this job
Please note: This position will require working weekend and weekday hours.
POSITION SUMMARY
In the Utilization Management Nurse Consultant position you will work in collaboration with Medical Director, perform Utilization Management activities for members admissions and continued stay in a group of assigned facilities via fax or remote EHR access.
Fundamental Components include, but are not limited to:
* Review assigned member's admissions and continued stay requests
* Utilized established criteria
* Document supporting clinical information and findings
* Discuss Recommendation with medical Director
BACKGROUND/EXPERIENCE desired:
* Managed Care experience; Required
* 3-5 years of clinical experience; Required
* Certified Case Manager or NCQA; Preferred
* 1- 2 years Medicare Experience; Highly Preferred
EDUCATION
The minimum 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 desired
FUNCTIONAL EXPERIENCES
Functional - Nursing//4-6 Years
DESIRED SKILLS
Service/Providing Solutions to Constituent Needs/ADVANCED
Benefits Management/Interacting with Medical Professionals/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.
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.
POSITION SUMMARY
In the Utilization Management Nurse Consultant position you will work in collaboration with Medical Director, perform Utilization Management activities for members admissions and continued stay in a group of assigned facilities via fax or remote EHR access.
Fundamental Components include, but are not limited to:
* Review assigned member's admissions and continued stay requests
* Utilized established criteria
* Document supporting clinical information and findings
* Discuss Recommendation with medical Director
BACKGROUND/EXPERIENCE desired:
* Managed Care experience; Required
* 3-5 years of clinical experience; Required
* Certified Case Manager or NCQA; Preferred
* 1- 2 years Medicare Experience; Highly Preferred
EDUCATION
The minimum 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 desired
FUNCTIONAL EXPERIENCES
Functional - Nursing//4-6 Years
DESIRED SKILLS
Service/Providing Solutions to Constituent Needs/ADVANCED
Benefits Management/Interacting with Medical Professionals/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.
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.
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