Skip to main content

Nurse Careers

At Aetna, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.

Back to Job Navigation (Overview)

Success Profile

What makes a successful nurse? Here are the traits we are looking for:

  • Collaborative
  • Deadline-oriented
  • Organized
  • Problem Solver
  • Results Driven
  • Technology Savvy
  • Adaptable
  • Compassionate
  • Detail Oriented
  • Flexible
  • Good Listener
  • Open Minded
  • Responsible
  • Team Player

Back to Job Navigation (Success)

Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

Back to Job Navigation (Rewards)

Job Details

Utilization Management Registered Nurse Consultant - Full-Time Telework

Primary Location: Birmingham, Alabama
Additional Locations: AL-Birmingham, AZ-Tucson, CO-Denver, FL-Orlando, GA-Atlanta, IA-Cedar Rapids, LA-New Orleans, MA-Lowell, MO-St Louis, NE-Omaha, NM-Albuquerque, OH-Cincinnati, OH-New Albany, OK-Oklahoma City, TN-Nashville, TX-Austin, WA-Seattle, WI-Waukesha
Apply
Description:
This position is with American Health Holding/Aetna, a CVS Health company. The UM Nurse utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. The hours for this position are 11:30AM-8PM ET. Position supports a clinical call center environment with requirement of occasional weekends.

This is a full-time telework (work at home) position following a required two-week on-site training in New Albany, OH upon hire.

Fundamental Components:
- 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/guideline, 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.

Background Experience:
-Active, unrestricted Registered Nurse (RN) License required
-Utilization Management (UM) experience required
-3+ years of clinical experience required
-Managed Care experience preferred
-Exemplary clinical documentation skills; critical thinking skills
-Must be able to demonstrate computer proficiency skills and work independently as a self starter in a fast paced production and metrics driven environment


Additional Job Information:

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




Exemplary clinical
documentation skills; critical thinking skills Must be able to demonstrate
computer proficiency skills and work independently as a self starter in a fast
paced production and metrics driven environment











This position is with
American Health Holding, an Aetna Company. The UM Nurse utilizes clinical
skills to coordinate, document, and communicate all aspects of the
utilization/benefit management program. The hours for this position are
11:30-8PM ET. Position supports a clinical call center environment with
requirement of occasional weekends.







Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Turning Data into Information

Desired Skills:
Benefits Management - Maximizing Healthcare Quality, General Business - Demonstrating Business and Industry Acumen, Technology - Leveraging Technology

Functional Skills:
Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Precertification, Nursing - Medical-Surgical Care

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word

Education:
Nursing - Registered Nurse

Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
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.

Click To Review Our Benefits (PDF)

Apply

Sign up for Job Alerts

Explore This Area

Check out where you could be working if you apply.

View Map

Similar Jobs

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.