Utilization Management Nurse Associate (LPN/LVN/RN)

Company Name:
Req ID: 22799BR
External candidates must be within a commutable distance of an Aetna office.Candidates must have at least 3 years of clinical nursing experience.POSITION SUMMARYThe Utilization Management Nurse Associate utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations working in a very fast paced environment.The UM Nurse Associate also applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services. The UM Nurse Associate coordinates and communicates with providers and other parties to facilitate optimal care and treatment. They also identify members who may benefit from care management programs and facilitates referrals as well as identify opportunities to promote quality effectiveness of healthcare services and benefit utilization. Hours of Operation 8am - 8pm EST Monday through Friday. Work hours will be based on location and time zone. Overtime may be required.BACKGROUND/EXPERIENCEManaged Care experience preferred3-5 years of clinical experience required-Performs medical necessity reviews for requests requiring prior authorization -Presents clear and accurate documentation that demonstrates proper application of clinical criteria -Collaborates with staff to ensure timely and accurate processing of authorization requestEDUCATIONThe highest level of education desired for candidates in this position is a Associate's degree or equivalent experienceLICENSES AND CERTIFICATIONSNursing/Licensed Practical Nurse (LPN) is requiredorNursing/Registered NurseFUNCTIONAL EXPERIENCESFunctional - Nursing/Medical-Surgical Care/3-5 Years RequiredFunctional - Clinical/Medical/Precertification/1-3 YearsFunctional - Nursing/Managed Care/1-3 YearsTECHNOLOGY EXPERIENCESTechnical - Aetna Applications/Aetna Total clinical View/1-3 YearsTechnical - Desktop Tools/Microsoft Outlook/1-3 YearsREQUIRED SKILLSBenefits Management/Maximizing Healthcare QualityTechnology/Leveraging TechnologyGeneral Business/Applying Reasoned JudgmentDESIRED SKILLSGeneral Business/Maximizing Work Practices/Leadership/Collaborating for ResultsLeadership/Driving a Culture of ComplianceADDITIONAL JOB INFORMATIONAetna 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.
We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Clickhereto review the benefits associated with this position.
Job Function: Health Care

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