Job Description
ABOUT OUR COMPANY
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.
JOB GROUP SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
POSITION SUMMARY
The Nurse Consultant utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate inpatient healthcare management and effective discharge planning to improve the outcomes for members. More specifically, the inpatient care process includes: obtaining necessary information from providers and facilities concerning the care being provided to members; the assessment of a member's clinical condition and ongoing medical services and treatments to determine medical appropriateness; guide the setting for medical intervention to achieve optimum length of stay for members; the early identification of continuing care needs to facilitate discharge to the appropriate setting and discharge planning & coordination.
Job Requirements
ABOUT OUR COMPANY
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.
JOB GROUP SUMMARY
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge.
EDUCATION
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
LICENSES AND CERTIFICATIONS
Registered Nurse is required
FUNCTIONAL WORK EXPERIENCES
Nurses: Concurrent Review/discharge planning
Nurses: Precertification
Medical Management: Medical Management - Managed Care/Insurance Clinical Staff
Nurses: Discharge Planning
Nurses: Clinical coverage and policies
REQUIRED SKILLS
Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes
Collaborating for Results
Consult with Medical Directors on cases that don t meet coverage policy bulletin or clinical criteria guidelines
Identify, coordinate and monitor discharge plans
Interpersonal Communication
Manages services such that the member receives care in the most appropriate setting at the most appropriate cost
DESIRED SKILLS
Understanding Clinical Impacts
Work Management We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.
How to apply
To learn more about this opportunity, visit us athttp://api.careerbuilder.com/v1/joblink?DID=J3I2N36G99R8G4Y25B6&developerkey=WDAW0QF6HDXRBLW245F7 . Under requisition # select 29555 and submit your resume.
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace. No agencies, please.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.
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