Utilization Management Nurse AssociatePrimary Location: Dallas, TX
Additional Locations: TX-Dallas Apply
Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Requires LPN/LVN with unrestricted active license.
63221Fundamental 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 information to support the process of rendering appropriate medical necessity/benefit determinations 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 making timely and accurate medical necessity/benefit determinations Background Experience: -2+ years clinical experience required
-2+ years managed care experience preferred
-LPN/LVN with current unrestricted state licensure required Additional Job Information: LPN or LVN Required
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 Effective communication skills, both verbal and written. Required Skills: Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Shaping the Healthcare System, Benefits Management - Understanding Clinical Impacts Desired Skills: Benefits Management - Supporting Medical Practice, General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices, General Business - Turning Data into Information Functional Skills: Clinical / Medical - Precertification, Customer Service - Customer Service - Member Services - HMO products, Customer Service - Customer service - production environment Technology Experience: Aetna Application - QNXT, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word 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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