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UM Nurse Consultant

Primary Location: San Antonio, Texas
Additional Locations: TX-San Antonio
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POSITION SUMMARY
As a UM Nurse Consultant, you will help support the Amazon In Touch Care Premier Dedicated team to provide comprehensive coordination of medical services for the membership.

Fundamental Components:
This is an in-office Utilization Management position in the San Antonio office. This position is in an office environment using a computer station and may require sitting for extended periods of time. Candidates must possess good computer skills. This position is ideal for a Registered Nurse seeking a fast paced environment. The UM Nurse Consultant is an integral member of the care management team utilizing clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services thereby aiding in facilitating appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. More specifically, the inpatient care process includes: obtaining necessary information from providers and facilities; assessment of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness; guide the setting for medical intervention to achieve optimum length of stay for members. Authorize and coordinate the required services, in accordance with the benefit plan. The UM Nurse Consultant determines appropriate levels of coverage for inpatient stay using clinical judgment and application of Milliman Care Guidelines to meet the member's needs. The UM Nurse Consultant periodically evaluates the member's progress in meeting the inpatient care plan / discharge goals and revises and coordinates the plan with the hospital discharge planner, the attending physician, and the patient/family when appropriate. The UMNC assists in developing an approach to removing barriers and collaborates with UR departments to facilitate adherence to the care plan.

BACKGROUND/EXPERIENCE required:
  • RN with current, unrestricted state license & willing to obtain additional licensure
  • 3+ years of clinical experience, preferably in the acute care/hospital setting.
  • Candidate must possess strong customer service skills including: attention to customers & sensitivity to certain issues.

BACKGROUND/EXPERIENCE preferred:
  • Managed Care experience
  • BSN desirable but not required

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

LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required


FUNCTIONAL EXPERIENCES
Functional - Nursing/Concurrent Review/discharge planning/1+ Years
Functional - Nursing/Discharge Planning/1+ Years
Functional - Nursing/Medical-Surgical Care/1+ Years
Functional - Nursing/Clinical coverage and policies/1+ Years


TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook//
Technical - Desktop Tools/Microsoft Word//


REQUIRED SKILLS
Benefits Management/Interacting with Medical Professionals/ADVANCED
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Technology/Leveraging Technology/FOUNDATION


PREFERRED SKILLS
Leadership/Collaborating for Results/ADVANCED
Service/Providing Solutions to Constituent Needs/ADVANCED


Telework Specifications:
Considered only for current internal teleworkers (in any area); must be approved by hiring supervisor/manager PRIOR TO scheduling interview.

ADDITIONAL JOB INFORMATION
This position offers the candidate the opportunity to join an In Touch Care Premier Dedicated team (working primarily with only one plan sponsor) where 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. The Amazon In Touch Care Premier Dedicated team has a strong desire to deliver best-in-class service to the member's we serve and we strive to do this as a TEAM.

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.

Click To Review Our Benefits (PDF)

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