Utilization Management Nurse Consultant

Are you a highly motivated and skilled nurse looking for a challenging and rewarding career opportunity? Aetna is seeking a Utilization Management Nurse Consultant to join our dynamic team. In this role, you will have the opportunity to utilize your clinical expertise and critical thinking skills to help ensure the delivery of high-quality and cost-effective healthcare services for our members. If you are passionate about making a positive impact on the lives of others and have a strong background in utilization management, we want to hear from you! Join us in our mission to build healthier communities and make a difference in the healthcare industry.

1. Conduct utilization management activities to ensure the delivery of high-quality and cost-effective healthcare services for Aetna members.
2. Utilize clinical expertise and critical thinking skills to review and analyze medical information for appropriateness and necessity of services.
3. Collaborate with healthcare providers to develop and implement care plans that meet the needs of Aetna members.
4. Evaluate medical necessity and ensure compliance with evidence-based guidelines and Aetna policies.
5. Communicate with members, providers, and other healthcare professionals to facilitate the delivery of quality care.
6. Maintain accurate and thorough documentation of all utilization management activities.
7. Stay updated on industry trends and best practices in utilization management and apply them to daily responsibilities.
8. Provide education and support to members and providers on utilization management processes and procedures.
9. Participate in quality improvement initiatives to enhance the effectiveness and efficiency of utilization management.
10. Act as a resource for other team members and provide guidance and support as needed.
11. Adhere to all regulatory and compliance requirements.
12. Collaborate with other departments and teams to ensure a coordinated approach to patient care.
13. Help identify and implement process improvements to increase efficiency and effectiveness of utilization management.
14. Maintain confidentiality and handle sensitive information with professionalism and discretion.
15. Promote Aetna's mission and values by delivering high-quality and compassionate healthcare services.

According to JobzMall, the average salary range for a Utilization Management Nurse Consultant in Ohio, USA is between $65,000 and $85,000 per year. However, this can vary based on factors such as experience, location, and employer. Additionally, nurses in this field may also receive benefits such as health insurance, retirement plans, and paid time off.

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.