Aetna Utilization Management Nurse Consultant - RN in Albany, New York
Req ID: 55176BR
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program within the HealthCare Vertical Team.
Reviewing health care services to assure medical necessity
Applying clinical expertise to assure appropriate benefit utilization
Facilitate safe and efficient discharge planning
Work closely with facilities and providers to meet the complex needs of the member
3+ years of clinical experience required
1+ years of Review/Discharge planning preferred
1+ years of Precertification experience preferred
Managed Care experience preferred
The highest level of education preferred for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Nursing/Certified Case Manager is preferred
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Nursing/Clinical coverage and policies/1-3 Years
Functional - Clinical / Medical/Precertification/1-3 Years
Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Leadership/Collaborating for Results/ADVANCED
Current Aetna WAH will be considered based on performance to continue in that role
ADDITIONAL JOB INFORMATION
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company
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 candidates'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
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.