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Clinical Liaison UM Nurse RN

Primary Location: Norwalk, CT
Additional Locations: CT-Norwalk, IL-Chicago, NJ-Atlantic City, PA-Philadelphia, TX-Dallas, TX-Houston
The Clinical Liaison is clinical leader focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna members. They represent the plan and collaborate with providers and facilities, key stakeholders, and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.

Fundamental Components:
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical coverage and policies.

Focus on improving clinical outcomes, member and provider satisfaction within Aetna’s post-acute space:
  • Develop and maintain strong provider relationships
  • Promote positive business relationships, both internal and external
  • Serve as a technical, professional and business resource
  • Analyze and report business performance data to customers and colleagues
  • Develop and participate in presentations and consultations to/with existing and prospective customers and provider partners
  • Provide appropriate, timely assistance/management of complex clinical issues and act as a resource for UM for difficult discharges
  • Provide feedback from provider partners to enhance business processes and infrastructure to improve operational efficiency/excellence
  • Participate in internal and external health industry development efforts
  • Support strategic and operational direction for the delivery of performance based medical management for inpatient post- acute settings
  • Consults and lends expertise to internal and external constituents in the coordination and administration of the UM/ benefit management function
  • Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization
  • Collaborate with various constituents/departments to identify and solution service gaps in the network
  • Serve as a SPOC for routine provider issues; triages and escalates issues as appropriate
  • Educate providers on portals, protocols, policies, procedures and services to enhance the overall member/provider experience
  • Serve as a liaison between facilities, staff and other internal constituents
  • Travel is a MUST! Up to 80% travel expectation for this position

Background Experience:
3+ years of clinical experience in the post-acute setting (SNF, IPR, LTACH) required.
Managed care/utilization review experience preferred.
Strong verbal and written communication skills and the ability to communicate effectively with all levels of management required
Excellent consultative and communication skills, analytical ability, decisiveness, strong judgment and the ability to work effectively with staff and vendor required
Travel Required - may include weekend travel

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Understanding Clinical Impacts

Desired Skills:
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions

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

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

Nursing - Registered Nurse (RN)

Potential Telework Position:

Percent of Travel Required:
75 - 100%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by 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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