Utilization Management Nurse Consultant- Infertility
Description: Office-based position in Bismarck, ND.The Nurse Consultant utilizes clinical skills to review complex benefits, and apply plan and CPB criteria. You will work together with our dedicated Medical Directors for members seeking precertification for Infertility services. This role involves review of clinical records and outreach to providers and members to facilitate optimal utilization of Infertility benefits.63109 Fundamental Components: Gathers clinical details and applies the appropriate clinical criteria/guideline, policy, and procedure to make coverage determination/Medical Director recommendations. * Communicates with providers and other parties to facilitate care/treatment * Identifies members for referral opportunities to integrate with other programs * Identifies eligibility for benefit utilization and maximizing available benefits. * Consults and lends ability to other internal and external constituents in the coordination and administration of the Infertility benefits. Background Background: RN licensure required3+ years clinical background requiredInfertility/ mother-baby/ women's health background desiredUtilization management/ pre-cert background desiredManaged care background wanted Additional Job overview: This is an exciting opportunity to help our members become parents. It is a challenging and quickly changing clinical field. We are a small team that works closely with dedicated Medical Directors. Required skills: Benefits Management - Interacting with Medical Professionals, Service - Providing Solutions to Constituent Needs, Technology - Leveraging Technology Desired Skills: General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance Functional Skills: Medical Management - Medical Management - OB/GYN, Medical Management - Medical Management - Precertification Technology Background: Aetna Application - Aetna Total clinical View Education: Nursing - Registered Nurse 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. Applicant Privacy Details: Aetna takes our applicant's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal details (Social Security Number, Credit card info for direct deposit, etc.) from you via e-mail. Any requests for info will be discussed prior and will be conducted through a secure web siteprovided by the recruiter. Should you be asked for such details, please notify us immediately.
August 16 on Professional Diversity Network