Utilization Management Nurse Consultant
Are you a compassionate and driven registered nurse with a passion for helping others? Do you have experience in utilization management and a desire to use your skills to make a positive impact on people's lives? If so, Aetna is seeking a Utilization Management Nurse Consultant to join our team. In this role, you will have the opportunity to work closely with patients, physicians, and other healthcare professionals to ensure the most efficient and effective use of healthcare resources. We are looking for a highly motivated individual with exceptional critical thinking and communication skills, as well as a thorough understanding of healthcare regulations and guidelines. If you are ready to take your nursing career to the next level and make a meaningful difference in the healthcare industry, we encourage you to apply for this exciting opportunity.
- Conduct utilization management activities to ensure appropriate use of healthcare resources.
- Collaborate with patients, physicians, and other healthcare professionals to develop and implement individualized care plans.
- Review and analyze medical records to identify opportunities for improved patient care and cost savings.
- Communicate with insurance providers to obtain pre-authorization for medical procedures and treatments.
- Monitor and track patient progress and treatment plans to ensure optimal outcomes.
- Educate patients and their families on healthcare options and available resources.
- Stay up-to-date on healthcare regulations and guidelines to ensure compliance.
- Utilize critical thinking skills to make informed decisions on patient care and resource allocation.
- Document all interactions and interventions accurately and timely.
- Participate in team meetings and contribute ideas for process improvement.
- Act as a resource and support for other healthcare professionals.
- Maintain patient confidentiality and adhere to ethical standards.
- Continuously evaluate and adjust utilization management processes to improve efficiency and effectiveness.
- Provide guidance and training to new team members.
- Represent the company in a professional and compassionate manner at all times.
Bachelor's Degree In Nursing Or Related Field: Aetna Typically Requires Candidates For A Utilization Management Nurse Consultant Position To Have A Bachelor's Degree In Nursing Or A Related Field. This Education Provides A Strong Foundation In Nursing Principles, Patient Care, And Critical Thinking Skills, Which Are Essential For Success In A Utilization Management Role.
Active Rn License: Aetna Requires Candidates To Have An Active And Unrestricted Rn License In The State Where They Will Be Working. This Ensures That The Candidate Has Met All Necessary Requirements To Practice As A Registered Nurse And Is Knowledgeable About State-Specific Regulations And Guidelines.
Minimum Of 2-3 Years Of Clinical Experience: Aetna Typically Looks For Candidates With At Least 2-3 Years Of Experience Working In A Clinical Setting, Preferably In A Hospital Or Managed Care Environment. This Experience Provides A Strong Understanding Of Patient Care Processes, Medical Terminology, And Healthcare Systems, Which Are Crucial For A Utilization Management Role.
Knowledge Of Utilization Management Principles And Guidelines: Aetna Seeks Candidates Who Have A Solid Understanding Of Utilization Management Principles And Guidelines, Such As Interqual Or Milliman. This Knowledge Is Necessary For Effectively Reviewing And Evaluating Medical Records, Ensuring That Services Are Medically Necessary And Appropriate, And Identifying Potential Cost-Saving Opportunities.
Strong Communication And Critical Thinking Skills: Aetna Values Candidates Who Possess Strong Communication And Critical Thinking Skills. In A Utilization Management Role, It Is Essential To Communicate Effectively With Healthcare Providers, Patients, And Other Team Members. Critical Thinking Skills Are Also Necessary To Analyze Complex Medical Information, Make Informed Decisions, And Problem-Solve Effectively.
Data Analysis
Case management
Interpersonal Communication
Medical coding
Patient Advocacy
Cost Containment
prior authorization
Clinical Expertise
Insurance Policies
Utilization Review
Healthcare Regulations
Communication
Conflict Resolution
Leadership
Time management
Interpersonal Skills
creativity
Teamwork
Adaptability
Problem-Solving
Decision-making
According to JobzMall, the average salary range for a Utilization Management Nurse Consultant in Kansas, USA is between $65,000 and $85,000 per year. Factors such as years of experience, education, and specific job responsibilities can impact the exact salary within this range. Additionally, location within Kansas may also affect the salary for this role.
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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.
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