Utilization Management Nurse Consultant
POSITION SUMMARY
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license. It is important to have the ability to recognize quality of care issues and escalate them through established channels. This position requires strong computer skills, which includes the ability to navigate multiple systems. Candidates are expected to have strong written and verbal communication skills. The work is sedentary and includes telephonic outreach, review of electronic correspondence, and computer documentation.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nurses/Registered Nurse (RN) is required
REQUIRED SKILLS
Benefits Management/Interacting with Medical Professionals
Benefits Management/Maximizing Healthcare Quality
Leadership/Collaborating for Results
Service/Providing Solutions to Constituent Needs
FUNCTIONAL EXPERIENCES
Medical Management - Managed Care/Insurance Administration/1-3 Years
Medical Management - Discharge Planning/1-3 Years
Medical Management - Utilization Review/1-3 Years
Medical Management - Concurrent Review/1-3 Years
Customer Service - transaction based environment/1-3 Years
TECHNOLOGY EXPERIENCES
Desktop Tools/Microsoft Outlook/1-3 Years
Desktop Tools/Microsoft Excel/1-3 Years
Operating Systems/Windows/1-3 Years
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.