Utilization Management Nurse Consultant

Are you a Registered Nurse with a passion for improving healthcare outcomes through efficient and effective utilization management? Do you have experience in clinical review and case management? Aetna is seeking a Utilization Management Nurse Consultant to join our team and help us achieve our mission of building a healthier world. In this role, you will use your clinical expertise to assess and monitor the appropriate use of healthcare resources for our members. We are looking for a self-motivated and detail-oriented individual who thrives in a fast-paced and collaborative environment. If you are ready to make a meaningful impact on the healthcare industry, we want to hear from you.

1. Conduct clinical reviews and assessments of healthcare resources used by members.
2. Monitor and track utilization of healthcare services to ensure efficiency and effectiveness.
3. Collaborate with healthcare providers and other stakeholders to develop and implement care plans.
4. Utilize evidence-based guidelines and industry best practices to guide decision-making.
5. Identify and address potential gaps in care and recommend appropriate interventions.
6. Document all case management activities accurately and in a timely manner.
7. Stay up-to-date on industry trends and changes in healthcare policies and regulations.
8. Communicate effectively with members, providers, and team members to ensure timely and appropriate care.
9. Maintain confidentiality and adhere to HIPAA regulations in all interactions.
10. Participate in continuous quality improvement initiatives to enhance the utilization management process.
11. Collaborate with other healthcare professionals to develop and implement innovative strategies for improving healthcare outcomes.
12. Demonstrate a strong commitment to the mission and values of the organization.
13. Provide education and training to team members and healthcare providers on utilization management processes and procedures.
14. Support and promote a positive and collaborative work culture.
15. Continuously evaluate and improve utilization management processes to ensure efficiency and effectiveness.
16. Keep accurate and organized records of all utilization management activities.
17. Participate in team meetings and contribute ideas for improving overall performance and outcomes.
18. Adhere to all company policies, procedures, and guidelines.
19. Consistently meet or exceed performance metrics and goals.
20. Continuously seek opportunities for professional growth and development.

According to JobzMall, the average salary range for a Utilization Management Nurse Consultant in Michigan, USA is between $73,000 and $93,000 per year. This range can vary depending on factors such as experience, location, and specific job responsibilities. Some employers may also offer additional benefits and bonuses, which can impact the overall compensation package for this role.

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.