Utilization Management Nurse Consultant- InfertilityPrimary Location: Bismarck, ND
Additional Locations: ND-Bismarck Apply
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.
63109Fundamental 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: 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, Service - Providing Solutions to Constituent Needs, Technology - Leveraging Technology Desired Skills: General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance Functional Skills: Medical Management - Medical Management - OB/GYN, Medical Management - Medical Management - Precertification Technology Experience: Aetna Application - Aetna Total clinical View Education: Nursing - Registered Nurse 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.
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