Aetna Utilization Management Nurse Consultant (RN)- Registered Nurse in Bradenton, Florida

Req ID: 44524BR

This position is opened for telework in AR, LA, MS, AL, GA, SC, TN, and FL.

Please note there is one weekend position. You would be working four 10 hour days with two of them being Saturday and Sunday. All other openings will be standard business hours.

POSITION SUMMARY

In the Utilization Management Nurse Consultant position you will work in collaboration with Medical Director, perform Utilization Management activities for members admissions and continued stay in a group of assigned facilities via fax or remote EHR access.

Fundamental Components include, but are not limited to:

  • Review assigned member's admissions and continued stay requests

  • Utilized established criteria

  • Document supporting clinical information and findings

  • Discuss Recommendation with medical Director

BACKGROUND/EXPERIENCE desired:

  • Managed Care experience; Required

  • 3-5 years of clinical experience; Required

  • Certified Case Manager or NCQA; Preferred

  • 1- 2 years Medicare Experience; Highly Preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is desired

FUNCTIONAL EXPERIENCES

Functional - Nursing//4-6 Years

DESIRED SKILLS

Service/Providing Solutions to Constituent Needs/ADVANCED

Benefits Management/Interacting with Medical Professionals/ADVANCED

Telework Specifications:

Option for telework will be evaluated after a certain period of employment

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.

Job Function: Health Care