Utilization Management Nurse Consultant

Are you a compassionate and experienced registered nurse looking for a new opportunity? Aetna is seeking a Utilization Management Nurse Consultant to join our team! In this role, you will have the opportunity to make a positive impact on patients' lives by promoting quality and cost-effective healthcare services. We are looking for a motivated individual with strong clinical knowledge and excellent communication skills to join our dynamic team. If you are passionate about providing exceptional healthcare, we want to hear from you!

1. Conduct utilization management activities to ensure appropriate and cost-effective healthcare services are provided to patients.
2. Review medical records and treatment plans to determine the medical necessity and appropriateness of requested services.
3. Collaborate with healthcare providers and other team members to develop and implement care plans that meet patients' needs and promote positive health outcomes.
4. Communicate with patients, providers, and other stakeholders to educate them on utilization management processes and promote compliance with established guidelines.
5. Monitor and track utilization trends, identify potential areas for improvement, and make recommendations to management for process enhancements.
6. Stay up-to-date on industry regulations and guidelines related to utilization management and ensure compliance with all applicable laws and regulations.
7. Participate in quality improvement initiatives to promote the delivery of high-quality, cost-effective healthcare services.
8. Document all utilization management activities accurately and timely in accordance with company policies and procedures.
9. Serve as a resource for clinical staff and other team members, providing guidance and support on utilization management processes and procedures.
10. Maintain confidentiality of patient information and adhere to all HIPAA regulations.
11. Continuously strive to improve processes and procedures to enhance the overall efficiency and effectiveness of the utilization management program.
12. Act as an advocate for patients, ensuring their needs and preferences are considered in the utilization management process.
13. Collaborate with other departments and teams within the organization to promote interdisciplinary care and achieve shared goals.
14. Participate in training and development opportunities to maintain and enhance clinical knowledge and skills.
15. Uphold the mission and values of the organization and promote a positive and professional work environment.

According to JobzMall, the average salary range for a Utilization Management Nurse Consultant in Missouri, USA is between $70,000 and $90,000 per year. This can vary depending on factors such as experience, location, and specific job duties. Additionally, benefits and bonuses may also be included in the overall compensation package.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.