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Job Information

Aetna Utilization Management Nurse Consultant RN in Salt Lake City, Utah

Req ID: 73029BR

Job Description

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

Post-acute experience preferred

RN with current unrestricted state licensure required

Managed Care experience preferred

Utilization management experience preferred

Additional Job Information:

Typical office working environment with productivity and quality expectationsWork 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 environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboardingEffective communication skills, both verbal and written.

Benefit Eligibility

Benefit eligibility may vary by 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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