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.
What makes a successful nurse? Here are the traits we are looking for:
- Problem Solver
- Results Driven
- Technology Savvy
- Detail Oriented
- Good Listener
- Open Minded
- Team Player
Paid Time Off & Disability
Utilization Management Clinical Consultant (RN) Registered NursePrimary Location: Richmond, Virginia
Additional Locations: VA-Richmond Apply
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%
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
Mental Health/ is preferred
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:
58938Potential Telework Position: No Percent of Travel Required: 0 - 10%
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