Aetna UM Nurse Consultant in San Diego, California

Req ID: 50485BR

POSITION SUMMARY

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program within the HealthCare Vertical Team. Requires an RN with unrestricted active California license who resides in California.

Fundamental Components:

Reviewing 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.

BACKGROUND/EXPERIENCE:

Managed Care experience; Preferred

3-5+ years of clinical experience; Required

Experience in Utilization Review or using Milliman guidelines; Preferred

EDUCATION

The minimum level of education required for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is Required

Nursing/Certified Case Manager (CCM) is Desired

FUNCTIONAL EXPERIENCES

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

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

TECHNOLOGY EXPERIENCES

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

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

Benefits Management/Supporting Medical Practice/ADVANCED

Leadership/Driving a Culture of Compliance/FOUNDATION

Service/Providing Solutions to Constituent Needs/ADVANCED

Telework Specifications:

Full-Time Telework (WAH)

Considered only for locations in a specific region, state, or city; training period in the office may be required

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 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