Aetna Utilization Management Nurse Consultant in Albany, New York
Req ID: 54307BR
This position is for Utilization Management,for a high performing team called the Custom Care Management Unit collaboratively working with Willis Towers Watson The Utilization Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes
Fundamental Components but not limited to the following :
The ideal candidate is a Registered Nurse with an unrestrictive license. The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred. Candidate must possess good computer skills. Fundamental components related to the Custom Care Management Unit include but are not limited to; Utilizes assessment techniques to determine members level of health literacy, technology capabilities, and/or readiness to change. Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
Managed Care experience preferred
3-5 years of clinical RN experience required
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 is required active and unrestricted
Functional - Nursing/Case Management/1-3 Years
Functional - Nursing/Medical-Surgical Care/Critical Care/ICU/1-3 Years
Functional - Nursing/Discharge Planning/1-3 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years/End User
Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Supporting Medical Practice/ADVANCED
Leadership/Collaborating for Results/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Considered only for current internal teleworkers (in any area) Potential WAH after a year employment.
Internals can work ANYWHERE IN USA work at home.
ADDITIONAL JOB INFORMATION
This position offers the candidate the opportunity to join a dedicated Care Advocate team, working in National Accounts and collaboration with Willis Towers Watson. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and clinical excellence. This Unit has a strong desire to deliver best-in-class service to the Member's we serve and we strive to do this as a TEAM. 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. Together we will empower people to live healthier lives.
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.