Aetna Careers Near Me – UM Nurse Consultant

Job Responsibilities:

• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
• Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
• Identifies members who may benefit from care management programs and facilitates referral
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization

Job Requirements:

• 3+ years of clinical practice experience in an inpatient setting required
• 2+ years of experience as a RN with active unrestricted LA or compact state licensure.
• Must have the ability to obtain additional state licenses as needed.
• Must have the ability to work a schedule with rotating weekend on-call coverage.
• 1+ year of Utilization Management and/or Discharge Planning experience
• Managed care/utilization review experience preferred
• Discharge planning experience preferred
• Associate’s degree required, BSN preferred

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Baton Rouge, LA, US

Application Deadline: N/A

Apply Here

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