Utilization Management Nurse Consultant

This role is work at home with the potential to transition to office based in the future. Candidates must be local to Blue Bell, PA or Pittsburgh, PA.
This position utilizes clinical experience and critical thinking in a collaborative process to review and facilitate appropriate healthcare services/benefits for members
Fundamental components include but are not limited to:
The Utilization Management Nurse Consultant is an integral member of the care management team. Utilizing clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. More specifically, the inpatient care process includes: obtaining necessary information from providers and facilities; assessment of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness; guide the setting for medical intervention to achieve optimum length of stay for members. Authorize and coordinate the required services, in accordance with the benefit plan. Determines appropriate levels of coverage for inpatient stay by using clinical judgment and applying nationally recognized criteria including Milliman Care Guidelines to meet the member's needs. This position requires high proficiency with computers. Computer skills include navigating in multiple systems and web-based applications, use of mouse, and strong keyboarding skills, are essential for strong performance in this position. Familiarity with Microsoft Word and Excel, and the ability to copy and paste is also necessary.
An RN license is required
Managed Care experience preferred
3-5 years of clinical experience required
The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience.
Nursing/Registered Nurse (RN) is desired
Functional - Nursing/Concurrent Review/discharge planning/1-3 Years
Microsoft Explorer/1-3 Years
Microsoft Outlook/1-3 Years
Microsoft Word/1-3 Years
Benefits Management/Interacting with Medical Professionals
General Business/Applying Reasoned Judgment
Leadership/Driving a Culture of Compliance
Telework Specifications:
Considered only for locations in a specific region, state, or city; training period in the office may be required
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.
Employment Type Regular Career Band Description Professional

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