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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.

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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

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  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

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Job Details

Utilization Management Clinical Consultant (RN) Registered Nurse

Primary Location: Richmond, Virginia
Additional Locations: VA-Richmond
The candidate will review medical records of members to determine medical necessity of admission to medical facilities. The candidate is a liaison between Aetna and providers to advocate and manage patient care. The Concurrent Review Consultant utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. Weekends flexible schedule is needed.

Fundamental Components but not limited to the following:
* Manage inpatient admissions using specific guidelines for medical necessity 95%
* Liaison for Aetna and providers to approve/deny admissions 95%
* Discharge planning assistance 10%
*Team participation comprehensive staff rounds 5%
-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

3 years clinical practice experience, e.g., hospital setting, LTSS, alternative care setting such as home health or ambulatory care required.
Managed care/utilization review experience preferred
Managed Care/Managed Healthcare Professional is preferred
Mental Health/ is preferred
Proficiency with MS Office Suite.

The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.

LICENSES AND CERTIFICATIONS one of the following licenses are required:
Nursing/Registered Nurse
(RN) with unrestricted VA state license or VA Licensed independent behavioral health clinician (e.g. LCSW, LPC, LMFT, PhD, or Psy.D) w/VA state license.
Mental Health/Licensed Clinical Social Worker
Mental Health/Licensed Professional Counselor
Functional - Clinical / Medical/Concurrent review / discharge planning/4 Years
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/4 Years

Technical - Desktop Tools/Microsoft SharePoint/4 Years/End User
Technical - Desktop Tools/Microsoft Outlook/4 Years/End User
Technical - Desktop Tools/Microsoft Word/4 Years/End User
Technical - Desktop Tools/TE Microsoft Excel/4 Years/End User

Great teamwork environment.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates'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.

Potential Telework Position:

Percent of Travel Required:
0 - 10%

Click To Review Our Benefits (PDF)


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