At Aetna, a CVS Health Company, 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 Nurse Consultant (RN)Primary Location: Saint Paul, Minnesota
Additional Locations: MN-Minneapolis, MN-Plymouth, MN-St Paul Apply
Serve as a liaison between the Aetna Utilization Management team and Allina health system discharge planners. Work with Allina to provide appropriate documentation via EMR access and determine the best post-acute plan of care for each Allina Health | Aetna (AHA) member Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work.
Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.
67137Fundamental Components: 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 & Physical Requirements include but are not limited to (* denotes essential functions)
• 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
. Build relationships with Allina employees, AHA members and families, and Aetna utilization management staff.
Integral component on the interdisciplinary team assisting with connecting members with community services and accessing their benefits. •
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 Background Experience:
- Managed Care experience preferred
- 3+ years of clinical experience required
- Education and Certification Requirements
- RN with current unrestricted state licensure required.
- Additional Information (situational competencies, skills, work location requirements, etc.)
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Strong relationship-building and conflict resolution skills•
- Effective communication skills, both verbal and written.
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
- Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
- Work also requires travel through the metro area and around hospital campuses.
- Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC
- Typical office working environment with productivity and quality expectations
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