This is an in-office position. Internals who are already WAH can stay WAH if they are local to the Richfield, OH office.
This is a utilization review position reviewing precerts, retros, nonpars and concurrent review cases.
The UM Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management. Proactive discharge planning obtains the necessary information from providers and facilities concerning the care being provided to determine medical appropriateness optimum length of stay for members early identification of continuing care needs.
5+ years of clinical experience required
RN licensure in OH required
Managed Care experience preferred
Utilization management experience preferred
Excellent critical thinking skills
Computer literacy (Microsoft Outlook, Excel and Word)
Strong customer service skills
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
Functional - Nursing/Concurrent Review/discharge planning/4+ Years
Functional - Nursing/Critical Care/1+ Years
Functional - Nursing/Medical-Surgical Care/4+ Years
Functional - Nursing/Neonatal Intensive Care/1+ Years
Technical - Desktop Tools/Microsoft Word/4+ Years/End User
Technical - Desktop Tools/Microsoft Outlook/4+ Years/End User
Technical - Operating Systems/Windows/4+ Years/End User
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Benefits Management/Supporting Medical Practice/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Driving a Culture of Compliance/FOUNDATION
Service/Providing Solutions to Constituent Needs/ADVANCED
No opportunity for telework, only internals already WAH who are local to Richfield, OH office.
ADDITIONAL JOB INFORMATION
This is an office environment.
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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 for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.