RN - Utilization Management Review NursePrimary Location: Scottsdale, AZ
Additional Locations: AZ-Scottsdale Apply
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.
62447Fundamental Components: 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
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: 3+years of clinical experience required
RN with current unrestricted state licensure required.
Managed Care experience preferred
Utilization Management preferred Additional Job Information: Typical office working environment with productivity and quality expectations Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written. Required Skills: Benefits Management - Interacting with Medical Professionals, Service - Handling Service Challenges, Technology - Leveraging Technology Desired Skills: Benefits Management - Supporting Medical Practice, Leadership - Driving a Culture of Compliance, Service - Improving Constituent-Focused Processes Functional Skills: Clinical / Medical - Clinical claim review & coding, Clinical / Medical - Concurrent review / discharge planning, Clinical / Medical - Precertification, Medical Management - Medical Management - Clinical claim review, Medical Management - Medical Management - Clinical coverage and policies, Nursing - Clinical coverage and policies, Nursing - Concurrent Review/discharge planning, Nursing - Medical-Surgical Care Technology Experience: Aetna Application - Aetna Strategic Desktop Reporting, Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word Education: Nursing - Registered Nurse Potential Telework Position: Yes 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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