Utilization Management Nurse (RN)

Job Description

Description: Are you tired of bedside nursing?
Are you looking to get away from 12-hour hospital shifts while continuing to utilize your RN expertise to impact the lives of patients in your local community?
POSITION SUMMARY
As a 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. Looking for 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. Work from home opportunities may be available after 12-18 months of employment, determined by business need.
This is a dynamic and passionate team, with much support! This is ideal for an applicant seeking a fast paced environment.
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.

63325

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: .- Active, unrestricted RN License required.
- 2+ years of clinical experience required (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more!)
- Strong computer skills including toggling with Windows, Microsoft Office and Outlook and strong keyboarding skills required.
- Ability to exercise independent and sound judgment, strong decision-making skills and well-developed interpersonal skills required.
- Ability to manage multiple priorities, effective organizational and time management skills required.
- 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 experience preferred, but not required. Additional Job Information: Please assign to Leah Barwise, dedicated recruiter for High Point NC NACMST unit Education: Nursing - Registered Nurse (RN) Potential Telework Position: Yes Percent of Travel Required: N/A EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: 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.