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Aetna Inc.

RN- Utilization Manager Nurse Consultant (Registered Nurse) In office High Point, NC

Aetna Inc. - High Point, NC

We are seeking someone who enjoys working in an office in a high energy and motivated team environment and is detail oriented and highly organized. This role is located in the High Point, NC office and will require being in the office at least the first 12-18 months. This is a dynamic and passionate team, with much support!

As an Utilization Nurse Consultant you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.

This position is in an office environment using a computer station and may require sitting for extended periods of time. - Candidate must possess computer and typing skills. This is ideal for an applicant seeking a fast paced environment.

This is a full time position with business hours, Monday through Friday. To service west coast customers, nurses will be required to work 2-3 times a month until 9:00pm EST after training. Saturday work required after 6 months of training, 1-2 Saturdays per quarter can be expected, to meet federal and state regulated turn-around times. The office is located at 4050 Piedmont Parkway, High Point, NC.

Work from home opportunities may be available after 12-18 months of employment, determined by business need.

Fundamental Components:

-Gathers clinical information and applies the appropriate policy, procedure and clinical judgment to render coverage recommendation along the continuum of care

-Begins proactive discharge planning to facilitate safe and effective transitions to the next level of care, such as home or alternate discharge location.

-Communicates with providers and other parties to facilitate care/treatment, demonstrating superior customer service skills

-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

-Lends expertise to other internal and external constituents in the coordination and administration of the utilization management / benefit management function.

-This is a quick paced position that requires timeliness standards are met.

-All patient/provider contact is via phone or electronic media.

BACKGROUND/EXPERIENCE

Minimum of 2 years of clinical experience (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more!)

RN required, unrestricted

Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills.

Ability to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skills.

Ability to manage multiple priorities, effective organizational and time management skills.

This position is in an office environment using a computer station and may require sitting for extended periods of time.

Any managed care background is a plus.

Utilization Review is a huge plus.

EDUCATION

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

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse (RN) is required.

FUNCTIONAL EXPERIENCES

Functional - Nursing/Concurrent Review/discharge planning/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Operating Systems/Windows/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Telework Specifications:

Work from home opportunities may be available after 12-18 months of employment, determined by business need.

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.

8 days 23 hours ago

Aetna Inc.

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RN- Utilization Manager Nurse Consultant (Registered Nurse) In office High Point, NC Aetna Inc. - High Point, NC, United States

   

Location: High Point, NC

Company Profile:
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees’ dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The company’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.