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Utilization Management Nurse Consultant

Primary Location: San Antonio, Texas
Additional Locations: TX-San Antonio
This is an in office position in the San Antonio, TX office. Telework will be considered only for current internal teleworkers currently residing in TX.

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:
We are looking for a Utilization Management Nurse Consultant to join the San Antonio, Texas team in Public and Labor. In the UMNC role we are looking for a candidate who will be able to utilize 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.

The UMNC will gather clinical information and apply the appropriate clinical criteria, policy, procedure and clinical judgment to render coverage determinations/recommendation along the continuum of care. The UMNC communicates with providers and other parties to facilitate care/treatment and lends expertise to other internal and external constituents in the coordination and administration of the utilization management function.

UMNC will work collaboratively with the other members of the care advocate team. Requires an RN with unrestricted active license. Minimum of 3 years recent clinical experience. Must possess verbal, written communication skills, computer and keyboarding skills.

Background Experience:
RN licensure required
3+ years clinical experience required

Med-surg experience highly preferred
Utilization management experience preferred
Managed care experience preferred

Additional Job Information:
The candidate has the ability to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills. Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills.. Managed Care experience and prior experience within a telephonic customer service center type of environment is preferred. Candidate must possess good computer skills. Hours of operation are 8-6PM CST.

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

Desired Skills:
General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Service - Providing Solutions to Constituent Needs

Functional Skills:
Nursing - Clinical coverage and policies, Nursing - Concurrent Review/discharge planning, Nursing - Critical Care, Nursing - Medical-Surgical Care

Technology Experience:
Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Operating System - Windows

Nursing - Registered Nurse

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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