Skip to main content

Nurse Careers

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.

Back to Job Navigation (Overview)

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

Back to Job Navigation (Success)

Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

Back to Job Navigation (Rewards)

Job Details

Concurrent Review Nurse (RN)

Primary Location: New York, New York
Additional Locations: NY-New York
Apply
Description:
Concurrent Review Nurse focuses on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna member.

Fundamental Components:

Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care(*)

Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)(*) Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment(*)

Identifies members who may benefit from care management programs and facilitates referral(*)

Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization(*)



Background Experience:
  • Case Management Experience; Preferred
  • Utilization Management Experience; Required
  • Bilingual Fluency; Preferred
  • 3+ years clinical practice Experience; Required
  • RN with current unrestricted state licensure; Required.


  • Additional Job Information:
    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


    Education:
    Nursing - Registered 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. 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)

    Apply

    Sign up for Job Alerts

    Explore This Area

    Check out where you could be working if you apply.

    View Map

    Similar Jobs

    Join Our Talent Community

    Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.