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

NICU Review Nurse

Primary Location: Dallas, TX
Additional Locations: TX-Dallas
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Description:

Utilizes critical thinking and knowledge of program requirements, network and community resources, and Medicaid benefits to facilitate appropriate physical and behavioral healthcare and social services for members.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program



Fundamental Components:

Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function

Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care

Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)

Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment

Identifies members who may benefit from care management programs and facilitates referral

Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization



Background Experience:
  • Managed care/Utilization Review Experience; Preferred
  • NICU, Pediatric, Labor and Delivery experience; Preferred
  • 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care; Required.
  • Registered Nurse (RN) with unrestricted state license; Required


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

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment

Desired Skills:
Leadership - Collaborating for Results

Functional Skills:
Nursing - Concurrent Review/discharge planning, Nursing - Discharge Planning, Nursing - Emergency Room, Nursing - Maternal and Infant care, Nursing - Medical-Surgical Care

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

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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