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Utilization Management Nurse Consultant

Primary Location: Richfield, Ohio
Additional Locations: OH-Richfield
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Description:

Office-based position in Richfield, 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:
Utilizes 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. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Proactive discharge planning obtains the necessary information from providers and facilities concerning the care being provided to determine medical appropriateness optimum length of stay for members early identification of continuing care needs.

Background Experience:

RN licensure required

5+ years of clinical experience required (Med-surg, critical care, or similar experience is preferred)


Utilization management experience preferred

Managed care experience preferred

Computer literacy( Outlook, Excel and Word)

Excellent critical thinking skills



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
Effective communication skills, both verbal and written.

Required Skills:
Service - Demonstrating Service Discipline, Service - Providing Solutions to Constituent Needs, General Business - Applying Reasoned Judgment, Technology - Leveraging Technology

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

Functional Skills:
Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - General Management, Clinical / Medical - Precertification

Technology Experience:
Aetna Application - Aetna Internet site at www.aetna.com, Aetna Application - Aetna Strategic Desktop Reporting, Aetna Application - Aetna Total clinical View

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

Click To Review Our Benefits (PDF)

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