Aetna – New Albany, OH – UM Nurse Consultant

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ABOUT OUR COMPANY
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.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program

The Utilization Management Nurse Consultant works telephonically with providers and Aetna Medical Directors in determining best and most cost effective medical treatment for our members.  Medical necessity is determined by utilizing a variety of tools including review of clinical information and use of Milliman Care Guidelines.
This role allows highly skilled Registered Nurses to recommend the most appropriate care for our members while containing medical costs.  The nurse needs the appropriate medical knowledge as well as strong interpersonal, influencing and decision making skills.

Additionally the Nurse in this role needs to be highly organized, effective in time management, comfortable having his/her work measured, and have strong keyboard and telephone skills.

To view an Aetna Nurse Video and FAQ’s about being a nurse at Aetna, please go to www.aetna.com, click on ‘Careers’, ‘Experienced Professionals’ and Select ‘Nurses’.
www.aetna.com/about-aetna-insurance/aetna-careers/experienced_nursing.html

job Requirements

EDUCATION

• Bachelor’s degree or equivalent experience.

LICENSES AND CERTIFICATIONS

• Registered Nurse (RN) is required
• Certified Case Manager (CCM) is desired

FUNCTIONAL WORK EXPERIENCE

• Nursing: Discharge Planning
• Nursing: Precertification
• Nursing: Concurrent Review/discharge planning

REQUIRED SKILLS/EXPERIENCE

• 3-5 years clinical practice experience in an acute care hospital setting.
• RN with active unrestricted state licensure
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.
• Initiative, innovation and creativity
• Self directed and motivated to achieve positive outcomes for members
• Excellent/Proven clinical assessment skills with ability to make good decisions and exercise sound clinical and professional judgment as well as manage multiple priorities
• Driving a Culture of Compliance

ADDITIONAL JOB INFORMATION

• This is an office based position located in New Albany, OH.
• Position requires occasional rotation to late shift per week from 12:30PM – 9:00PM approximately once or twice monthly.

We value leadership, creativity and initiative.  If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.

Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V

Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna’s Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.

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