Skip to main content

A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

UM Nurse Consultant

Primary Location: Bristol, Virginia
Additional Locations: DC-Washington, MD-Baltimore, VA-Bristol, VA-Chantilly
Apply
Description:
POSITION SUMMARY
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.

Fundamental Components:
Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. 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.

BACKGROUND/EXPERIENCE:
3+ years of clinical experience required
Managed Care experience preferred

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

LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required


FUNCTIONAL EXPERIENCES
Functional - Nursing/Concurrent Review/discharge planning/1+ Years
Functional - Medical Management/Medical Management - Hospital/1+ Years
Functional - Management/Management - Health Care Delivery/1+ Years


TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/TE Microsoft Excel/1+ Years/End User


REQUIRED SKILLS
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Supporting Medical Practice/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION


Telework Specifications:
Work at home position, preference to candidates in VA, MD or D.C.

ADDITIONAL JOB INFORMATION
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 candidates'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.


Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

Click To Review Our Benefits (PDF)

Apply

Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

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.