Aetna UM Nurse Consultant - Medicare Pre-Determination in Bismarck, North Dakota
Req ID: 66062BR
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license.
Fundamental Components included but are not limited to:
Utilizes clinical experience 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 information 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 expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
Qualifications Requirements and Preferences:
3+ years of clinical experience required
Managed Care experience preferred
RN with current unrestricted state licensure required
Nursing - Registered Nurse (RN)
Clinical / Medical - Direct patient care (hospital, private practice), Nursing - Clinical coverage and policies, Nursing - Concurrent Review/discharge planning, Nursing - Legal and benefit interpretation, Nursing - Medical-Surgical Care
Desktop Tool - Microsoft Explorer, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality, Benefits Management - Supporting Medical Practice, Benefits Management - Understanding Clinical Impacts
General Business - Applying Reasoned Judgment, General Business - Demonstrating Business and Industry Acumen, Service - Working Across Boundaries, Technology - Leveraging Technology
Additional Job Information:
Typical office working environment with productivity and quality expectations Work 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 fast paced changing environment Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Effective communication skills, both verbal and written.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.
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