Aetna Utilization Management Nurse Consultant in Scottsdale, Arizona

Req ID: 46330BR

This is an office based role in Scottsdale, AZ.

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 include but are not limited to:

  • 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/guidelines, 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

    RN license with current unrestricted state license is required

    3-5 years of clinical experience required

    Managed care experience preferred

    Previous utilization management review 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/Registered Nurse (RN) is required

    FUNCTIONAL EXPERIENCES

    Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years

    Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years

    Functional - Nursing/Clinical coverage and policies/1-3 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Explorer/1-3 Years/

    Technical - Desktop Tools/Microsoft Word/1-3 Years/

    Technical - Desktop Tools/Microsoft Outlook/1-3 Years/

    REQUIRED SKILLS

    Benefits Management/Interacting with Medical Professionals/ADVANCED

    Benefits Management/Maximizing Healthcare Quality/FOUNDATION

    General Business/Applying Reasoned Judgment/ADVANCED

    DESIRED SKILLS

    Leadership/Fostering a Global Perspective/FOUNDATION

    Technology/Leveraging Technology/FOUNDATION

    ADDITIONAL JOB INFORMATION

    Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding- Effective communication skills, both verbal and written- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment- Sedentary work involving periods of sitting, talking and listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer (simultaneously)- Work requires the ability to perform close inspection of hand written and computer generated documents as well as PC monitor- Typical office working environment with productivity and quality expectations.

    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.

Job Function: Health Care