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Infertility Utulization Management Nurse

Primary Location: Bismarck, North Dakota
Additional Locations: ND-Bismarck
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Description:

Office-based in Bismarck, ND.

The Nurse Consultantutilizes clinical skills to review complex benefits, and apply plan and CPBcriteria. You will work closely with our dedicated Medical Directors formembers seeking precertification for Infertility services. This role involvesreview of clinical records and outreach to providers and members to facilitateoptimal utilization of Infertility benefits.



Fundamental Components:

• Gathers clinical
information and applies the appropriate clinical criteria/guideline, policy,
and procedure to make coverage determination/Medical Director recommendations.


• Communicates with providers and other parties to facilitate care/treatment



Identifies members for referral opportunities to integrate with other programs


• Identifies eligibility for benefit utilization and maximizing available
benefits.


• Consults and lends expertise to other internal and external
constituents in the coordination and administration of the Infertility
benefits.



Background Experience:

RN licensure required

3+ years clinical experience required


Infertility/ mother-baby/ women's health experience preferred

Utilization management/ pre-cert experience preferred

Managed care experience preferred



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.
This is an exciting
opportunity to help our members become parents. It is a challenging and quickly
changing clinical field. We are a small team that works closely with dedicated
Medical Directors.


Required Skills:
Benefits Management - Interacting with Medical Professionals, General Business - Applying Reasoned Judgment, Technology - Leveraging Technology

Functional Skills:
Medical Management - Medical Management - Precertification, Nursing - OB/GYN

Technology Experience:
Aetna Application - Aetna Total clinical View

Education:
Nursing - Registered Nurse (RN)

Potential Telework Position:
No

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)

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