UM Nurse Consultant

Aetna is presently looking of UM Nurse Consultant on Mon, 22 Jan 2018 21:53:43 GMT. Registered Nurse (RN) with active state license in good standing required. This position will sit in either the Urbandale, IA office or the Omaha, NE office.... UM Nurse Consultant Location: Urbandale, Iowa Description: Aetna is presently looking of UM Nurse Consultant right now, this occupation will be assigned in Iowa. Detailed specification about this occupation opportunity please read the description below. This position will sit in either the Urbandale, IA office or the Omaha, NE office. Internals that are currently WAH can remain WAH, but still must be located in the region (NE, IA, SD or ND). 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. Additional Job Responsibilities: Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies 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 Background/Experience: Minimum of 3 years clinical experience required (Med/Surg or post-acute preferred) Managed Care experience preferred Education: The minimum level of education desired for candidates in this position is a Associate's degree or equivalent experience Licenses and Certifications: Registered Nurse (RN) with active state license in good standing required Functional Experiences: Functional - Nursing/Concurrent Review/discharge planning/1+ Years Functional - Nursing/Clinical coverage and policies/1+ Years Functional - Nursing/Legal and benefit interpretation/1+Years Technology Experiences: Technical - Desktop Tools/Microsoft Outlook/1+Years/End User Technical - Desktop Tools/Microsoft PowerPoint/1+ Years/End User Technical - Desktop Tools/Microsoft Word/1+ Years/End User Required Skills: Benefits Management/Interacting with Medical Professionals/3+ years/ADVANCED Benefits Management/Maximizing Healthcare Quality/1+ years/FOUNDATION General Business/Consulting for Solutions/1+ years/FOUNDATION Desired Skills: General Business/Turning Data into Information/1+ years/FOUNDATION Leadership/Collaborating for Results/3+ years/ADVANCED Finance/Managing Aetnas Risk/1+ years/FOUNDATION Additional Job Information: Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately. - . If you were eligible to this occupation, please send us your resume, with salary requirements and a resume to Aetna. Interested on this occupation, just click on the Apply button, you will be redirected to the official website Apply UM Nurse Consultant Here This occupation will be started on: Mon, 22 Jan 2018 21:53:43 GMT Apply tot his job