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Nurse Careers

At Aetna, a CVS Health Company, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our more than 4,000 nurses are central to turning our member’s health ambitions, big and small, into achievements. Your role will include helping members stay well, manage health conditions, and access the right care at the right time. As you do this, we’ll support you in achieving more in your life and your work.

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Success Profile

What makes a successful nurse? Here are the traits we are looking for:

  • Collaborative
  • Deadline-oriented
  • Organized
  • Problem Solver
  • Results Driven
  • Technology Savvy
  • Adaptable
  • Compassionate
  • Detail Oriented
  • Flexible
  • Good Listener
  • Open Minded
  • Responsible
  • Team Player

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Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

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Job Details

Utilization Management Notice of Action Nurse Letter Writer (LPN/LVN) TSK

Primary Location: Dallas, Texas
Additional Locations: TX-Dallas
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Description:
At Aetna Better Health of Texas, we are committed to helping people on their path to better health. By taking a total and connected approach to health, we guide and support our members so they can get more out of life, every day. We are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to improving the lives of Texas STAR Kids members. We value diversity and are dedicated to helping you achieve your career goals.


Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Responsible for generating denial/ approval letters with appropriate attachments for member rights and fair hearing forms. Supports both concurrent review and prior authorization team. Requires LPN/LVN with unrestricted active license.

Fundamental Components:
Promotes/supports quality effectiveness of Healthcare Services and benefit utilization. Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration. Collects/updates determination information to support the process of communicating appropriate medical necessity/benefit determinations to providers/members. Initiates generation of denial/approval letter and ensures appropriate member rights and fair hearing forms are attached. Collaborates with medical directors/ nurses when clarification is needed. Accurately saves letter information to appropriate logs for future reference. Identifies members for referral opportunities to integrate with other products, services and/or programs. Utilizes clinical experience, criteria/guidelines, policies and procedures in support of communicating timely and accurate medical necessity/benefit determinations to providers/members.

Background Experience:
  • 3+ years clinical experience required
  • LPN/LVN with current unrestricted state licensure required
  • 2+ years managed care experience preferred
  • Pediatric/Adolescent experience preferred
  • 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
  • Detail oriented when cross referencing clinical, determination, and letter content
  • Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel. Strong keyboard and mouse skills required
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants
  • Typical office working environment with productivity and quality expectations.
  • Work requires the ability to perform close inspection of handwritten 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


Additional Job Information:
Typical office working environment with productivity and quality expectationsWork 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 environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Clinical Licensure:
Licensed Practical 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.

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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