Utilization Management Nurse Consultant

Hello! Are you a registered nurse with a passion for improving healthcare outcomes? Aetna is currently seeking a Utilization Management Nurse Consultant to join our dynamic team. In this role, you will have the opportunity to utilize your clinical expertise to ensure the appropriate utilization of healthcare resources and promote quality, cost-effective care for our members. We are looking for a highly motivated and detail-oriented individual with excellent communication and critical thinking skills. If you are ready to make a positive impact in the healthcare industry, then we would love to hear from you. Read on for more details about the qualifications and responsibilities of this exciting opportunity.

1. Conduct Utilization Management: The Utilization Management Nurse Consultant will be responsible for reviewing and analyzing healthcare utilization data to determine the appropriate level of care for Aetna members. This includes reviewing medical records, assessing the medical necessity of services, and identifying potential cost-saving opportunities.
2. Promote Quality Care: The primary responsibility of this role is to ensure that Aetna members are receiving high-quality, cost-effective healthcare services. The Utilization Management Nurse Consultant will work closely with healthcare providers to promote evidence-based care and identify opportunities for improvement.
3. Utilize Clinical Expertise: The ideal candidate for this role will have a strong background in nursing and a deep understanding of clinical best practices. They will use their knowledge and experience to make informed decisions about the appropriate level of care for Aetna members.
4. Communicate Effectively: Excellent communication skills are essential for this role. The Utilization Management Nurse Consultant will need to effectively communicate with healthcare providers, members, and Aetna staff to ensure that all parties are informed and on the same page regarding healthcare utilization and quality of care.
5. Exercise Critical Thinking: This role requires an individual who can think critically and make sound decisions based on complex medical information. The Utilization Management Nurse Consultant will need to consider multiple factors, such as medical necessity, cost, and quality, to make informed decisions.
6. Collaborate with Team: The Utilization Management Nurse Consultant will work closely with a team of healthcare professionals, including other nurses, physicians, and administrative staff. They will need to collaborate effectively with their team to achieve common goals and ensure the best outcomes for Aetna members.
7. Stay Up-to-Date on Healthcare Trends: The healthcare industry is constantly evolving, and it is essential for the Utilization Management Nurse Consultant to stay current on industry trends, best practices, and regulatory changes. This will ensure that Aetna members receive the most up-to-date and effective care.
8. Maintain Documentation: The Util

According to JobzMall, the average salary range for a Utilization Management Nurse Consultant is between $68,000 and $110,000 per year. This can vary depending on factors such as location, experience, and employer. Some employers may also offer bonuses and benefits as part of the 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.