UM Nurse Consultant - Aetna (Overland Park, KS) in Lawrence, Kansas For Sale
Req ID: xxxx7BR 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.These positions are with American Health Holding (AHH). Telecommuters must have a separate dedicated area for HIPPA compliance. The hours for these positions range from as early as 8:00 AM and ending as late as 8:00 PM ET.a) This position is work at home from any locationMinimum internet requirements for a telecommuting position include: A separate wired Internet connection Minimum download speed of 6MB Minimum upload speed of 1MB Satellite and other wireless Internet are NOT supportedPOSITION SUMMARY - Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. - Requires an RN with unrestricted active license. - Requires at least fives years acute hospital care.- Clinical is processed against approved criteria.- All aspects of the utilization process (including precertification, concurrent and retro reviews and discharge planning) require adherence to URAC standards, various laws and regulations and company policies and procedures.- The UM nurse consultant needs to be highly organized, effective in time management, ability to manage multiple priorities, have strong teamwork skills, comfortable having his/her work measured, and have strong keyboard and telephone skills. EDUCATIONThe highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Registered Nurse (RN) is requiredREQUIRED FUNCTIONAL EXPERIENCESNursing/Medical-Surgical Care/Clinical Experience/3+ YearsUtilization Review/Utilization Management/1+ YearsREQUIRED SKILLSTechnology/Leveraging TechnologyGeneral Business/Turning Data into InformationBenefits Management/Interacting with Medical ProfessionalsDESIRED SKILLSBenefits Management/Maximizing Healthcare QualityAetna does not permit the use of tobacco related products or drugs in the workplace. Job Function: Health Care
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