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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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Benefits

  • Health

  • Wellness

  • Financial

  • Paid Time Off & Disability

  • Life Insurance

  • Additional Benefits

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Job Details

Registered Nurse (RN) Manager Utilization Management - 57846BR

Primary Location: San Diego, California
Additional Locations: CA-San Diego
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Description:
The Manager of Utilization Management is responsible for the operational management of the Aetna Better Health of California Medicaid/ Medi-Cal Utilization review program to carriers, third-party administrators, and employers, including, staffing, training, monitoring, evaluation, and process efficiency.

#LI-TS1

Fundamental Components:
Provides management and direction for Workers Compensation utilization review; including, staffing, training, monitoring and evaluating. Reviews the timeliness, appropriateness, and medical necessity of the utilization review process performed by the staff; prepares reports detailing the productivity metrics. Actively participates in the development, implementation, and oversight of the department’s activities; serves in an adjunct role for policy and procedure development and implementation. Assists in the identification of issues which may adversely impact the attainment of department goals and objectives. Collaborates with other departments to identify and coordinate managed care activities. Attends meetings with internal workgroups, account management, and clients. Responsible for operational compliance with State and Federal law regarding handling of utilization review processes; ensures compliance with national accrediting body standards regarding utilization review policies and procedures. Recruits, develops, and motivates staff. Initiates and communicates a variety of personal actions including employment, termination, performance reviews, salary reviews, and disciplinary actions. Performs other related duties as required.

Background Experience:
  • 1+ recent and related supervisory experience preferred
  • Experience in program and process development; required
  • 3+ years recent and related experience in utilization review; required
  • 5+ years clinical experience; required
  • Managed Care Experience; required
  • Computer skills and ability to analyze health care data; required
  • Registered Nurse (RN) with active state license in good standing in CA; Required
  • Bachelor's degree in a closely-related field, or equivalent combination of education and experience; required
  • Medi-Cal (California Medicaid) experience; preferred


Potential Telework Position:
No

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

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