Utilization Management Nurse Consultant
Boynton Beach, FL
Description: Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.65342 Fundamental Components: Utilizes clinical background 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 info 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 ability to other internal and external constituents in the coordination and administration of the utilization/benefit management function Background Background: 3+ years of clinical background required1+ years of Microsoft office background requiredSub Acute (SNF, LTAC) background preferredManaged Care background desiredRN with current unrestricted state licensure required Additional Job Info: Typical office work atmosphere with productivity and quality expectationsWork 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 quick paced changing environmentPosition requires proficiency with technical skills which includes navigating multiple systems and keyboardingEffective communication abilities, both verbal and written. Key skills: Benefits Management - Maximizing Healthcare Quality, General Business - Demonstrating Business and Industry Acumen, Leadership - Driving a Culture of Compliance Desired Skills: Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment, General Business - Communicating for Impact Functional Skills: Management - Management - Health Care Delivery, Medical Management - Medical Management - Hospital, Nursing - Concurrent Review/discharge planning Technology Background: Desktop Tool - Word, Desktop Tool - TE Ms excel Education: Nursing - Registered Nurse (RN) 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. 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 info (Social Security Number, Credit card info for direct deposit, etc.) from you via e-mail. Any requests for details 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.
October 18 on Professional Diversity Network