Aetna UM Nurse Associate in Doral, Florida
Req ID: 54352BR
Utilizes clinical skills to support the coordination, documentation and communication of specialty medications and/or benefit administration determinations.
Promotes/supports quality effectiveness of Healthcare Services and benefit utilization
Collects information to support the process of rendering appropriate medical necessity/benefit determinations
Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations
2+ years clinical experience required
LPN/LVN or RN with current unrestricted state license required
2+ years managed care experience preferred
The minimum level of education required for candidates in this position is an Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS:
Nursing/Licensed Practical Nurse is desired
Functional - Nursing/Clinical coverage and policies/1+ Years
Technical - Aetna Applications/1+ Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
General Business/Applying Reasoned Judgment/FOUNDATION
100% WAH position
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 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.