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Aetna is now a CVS Health Company

Utilization Management Nurse Consultant

Primary Location: New Albany, OH
Additional Locations: OH-New Albany
Office-based position in New Albany, OH.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.

Fundamental Components:
We are looking for a Utilization Management Nurse Consultant to join the New Albany Dedicated Unit. In the Utilization Management Nurse Consultant role we are looking for a candidate who will be able to utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. The UMNC will gather clinical information and apply the appropriate clinical criteria, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. The UMNC communicates with providers and other parties to facilitate care/treatment and lends expertise to other internal and external constituents in the coordination and administration of the utilization management function. UMNC will work collaboratively with the other members of the care advocate team. Requires an RN with unrestricted active license. Minimum 3 to 5 years of recent experience. Must possess strong verbal, written communication skills, computer and keyboarding skills.

Background Experience:
RN licensure in OH required
3+ years clinical experience required

Utilization review experience preferred
Managed Care experience preferred
Accurately touch type on a keyboard at efficient speed

Additional Job Information:
The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred. Candidate must possess good computer skills. Hours of operation are 8:00 AM to 10:00 PM EST Monday - Friday. Evening Shift rotation (1:30 PM to 10:00 PM) 1-2 times a month along with occasional Saturday 8:00AM-4:30PM.

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Service - Providing Solutions to Constituent Needs

Functional Skills:
Nursing - Clinical coverage and policies, Nursing - Concurrent Review/discharge planning, Nursing - Critical Care, Nursing - Medical-Surgical Care

Technology Experience:
Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows

Nursing - Registered Nurse (RN)

Potential Telework Position:

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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