UM Nurse Consultant RNPrimary Location: Bismarck, ND
Additional Locations: ND-Bismarck Apply
|This position will start in-office at the Bismarck, ND location, but will consider current Aetna employees who work from home.|
The Nurse Consultant utilizes clinical skills to review complex benefits, and apply plan and CPB criteria. You will work closely with our dedicated Medical Directors for members seeking precertification for Infertility services. This role involves review of clinical records and outreach to providers and members to facilitate optimal utilization of Infertility benefits. Requires an RN with unrestricted active license.
69083Fundamental 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 function. Consults and lends expertise to other internal and external constituents in the coordination and administration of the Infertility benefits. Background Experience:
- RN with current unrestricted state licensure required.
- 3-5 years of clinical experience required.
- Managed Care experience preferred.
- Infertility experience preferred.
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