At Aetna, 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.
What makes a successful nurse? Here are the traits we are looking for:
- Problem Solver
- Results Driven
- Technology Savvy
- Detail Oriented
- Good Listener
- Open Minded
- Team Player
Paid Time Off & Disability
Utilization Management Clinical Consultant - Registered NursePrimary Location: Houston, Texas
Additional Locations: TX-Houston Apply
The Utilization Management Nurse Consultant utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations working in a very fast paced environment.
Utilization Management Nurse Consultant applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.
Utilization Management Nurse Consultant coordinates and communicates with providers, members and other parties to facilitate optimal care and treatment often collaborating with Aetna medical directors and other internal departments. They identify members who may benefit from care management programs and facilitates referrals as well as identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
Utilization Management Nurse Consultant utilizes their technical skills to multitask through multiple systems at a rapid pace in order to process Pre certification requests timely and accurately.
They are proficient in both verbal and written communication in order to request information, review clinical material, make appropriate decisions based on medical necessity and/or benefits and communicate those decisions to both providers and members
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
1+ years of Review/Discharge planning experience preferred
Med-Surge experience preferred
The minimum level of education for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse is required
Functional - Nursing/Medical-Surgical Care/4+ Years
Functional - Medical Management/Medical Management - Precertification/1+ Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4+ Years
Functional - Nursing/Legal and benefit interpretation/1+ Years
Technical - Aetna Applications/Aetna Total clinical View/1+ Years/End User
Technical - Aetna Applications/Aetna Strategic Data Warehouse/1+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
ADDITIONAL JOB INFORMATION
This position is for the nurse who wants challenge in a fast paced, always changing environment. The nurse uses their clinical knowledge, communication skills and independent critical thinking skills towards interpreting criteria and policies and procedures to provide the best and most appropriate treatment, care and services for members. This position is based on a 40 hour week Monday through Friday and is exempt.
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.
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