Jobs at Aetna – UM Nurse Consultant

Job Description:

This position is a remote role with a working schedule of Friday, Saturday, Sunday and Monday, 4-10 hour shifts to be determined by manager to meet provider and business needs.

Job Responsibilities:

• Coordinates/communicates with providers and other parties to facilitate optimal care/treatment.
• Applies critical thinking and knowledge in clinical 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.
• Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgement to render coverage determination/recommendation/discharge planning along the continuum of care.
• Identifies members who may benefit from care management programs and facilitates referral.
• 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.)
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Job Requirements:

• WIllingness to obtain additional state licenses as needed.
• RN with unrestricted state licensure required.
• 3+ years of clinical practice experience in an inpatient setting required.
• Ability to work holidays on a rotating basis to support business needs.
• Work From Home fully remote, working schedule of Friday, Saturday, Sunday and Monday, 4-10 hour shifts to be determined by manager to meet provider and business needs.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Louisville, KY, US

Application Deadline: N/A

Apply Here

vacancyoptions.com