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Utilization Management Nurse Consultant

Primary Location: Macon, Georgia
Additional Locations: CA-Fremont, CT-Stamford, GA-Macon, MN-Minneapolis, MO-Chesterfield, ND-Bismarck, SC-Columbia, TX-Austin
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Description:

Full time telework opportunity open to internal Aetna candidates across the country.


The Utilization Nurse Consultant for the Medicare OD Team facilitates the successful audit and review of Medicare Pre-service SOD denial documentation and denial letters prior to mailing. Develops, implements and offers guidance and coaching to staff as needed while supporting Health Strategies, tactics, policies and programs that ensure the delivery of accurate Medicare SOD correspondence, services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.



Fundamental Components:
Utilizes managed care UMNC clinical experience and skills in supports of the market territories in transition to minimize impact to the company as it applies to Medicare regulations and compliance. Successfully working and communicating across Aetna markets to ensure compliance with Medicare OD cases.



Background Experience:


RN licensure required



3+ years clinical Utilization management managed care experience within Aetna required



Excellent computer skills



Excellent time management skills





Additional Job Information:


Typical office working environment with productivity and quality expectations

Work requires the ability to perform close inspection of computer generated
documentation.

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.

Schedule Monday thru Friday-Hours TBD (day-time)



Required Skills


Service - Case Administration,
Leadership - Collaborating for Results, General Business - Communicating for
Impact


Desired Skills


Benefits Management - Interacting
with Medical Professionals, Benefits Management - Understanding Clinical
Impacts








Required Skills:
Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts, Leadership - Driving a Culture of Compliance

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen

Functional Skills:
Management - Management - Health Care Delivery, Medical Management - Medical Management - Hospital, Nursing - Concurrent Review/discharge planning

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

Education:
Nursing - Registered Nurse (RN)

Potential Telework Position:
Yes

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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