Utilization Management Clinical Consultant Nurse RN Texas Star Kids

AETNA

Full Time
Dallas, TX
Posted 1 week ago

Description:
At Aetna Better Health of Texas, we are committed to helping people on their
path to better health. By taking a total and connected approach to health, we
guide and support our members so they can get more out of life, every day. We
are looking for people like you who value excellence, integrity, caring and
innovation. As an employee, you’ll join a team dedicated to improving the
lives of Texas STAR Kids members. We value diversity and are dedicated to
helping you achieve your career goals.

This position will be working out of the 2777 Stemmons Freeway location in
Dallas, TX

At Aetna Better Health of Texas, we are committed to helping people on their
path to better health. By taking a total and connected approach to health, we
guide and support our members so they can get more out of life, every day. We
are looking for people like you who value excellence, integrity, caring and
innovation. As an employee, you’ll join a team dedicated to improving the
lives of Texas STAR Kids members. We value diversity and are dedicated to
helping you achieve your career goals.

Utilizes clinical skills to coordinate, document and communicate all aspects
of the utilization/benefit management program. Applies critical thinking and
knowledge in clinically appropriate treatment, evidence based care and medical
necessity criteria for appropriate utilization of services. 71039
Fundamental Components:
Consults and lends expertise to other internal and external constituents in
the coordination and administration of the utilization/benefit management
function Gathers clinical information and applies the appropriate medical
necessity criteria/guideline, policy, procedure and clinical judgment to
render coverage determination/recommendation/discharge planning along the
continuum of care() Utilizes clinical experience and skills in a
collaborative process to evaluate and facilitate appropriate healthcare
services/benefits for members including urgent or emergent interventions (such
as triage / crisis support)() Coordinates/Communicates with providers and
other parties to facilitate optimal care/treatment() Identifies members who
may benefit from care management programs and facilitates referral()
Identifies opportunities to promote quality effectiveness of healthcare
services and benefit utilization(*)

Background Experience:

* Managed care/utilization review experience preferred.
* 3+ years’ clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
* Pediatric/Adolescent experience preferred
* Registered Nurse (RN) with unrestricted state license and with behavioral health experience preferred.
* Behavioral health experience is a plus.

Additional Job Information:
Typical office working environment with productivity and quality
expectationsWork requires the ability to perform close inspection of hand
written and computer generated documents as well as a PC monitor.Sedentary
work involving periods of sitting, talking, listening. Work requires sitting
for extended periods, talking on the telephone and typing on the
computer.Ability to multitask, prioritize and effectively adapt to a fast
paced changing environmentPosition requires proficiency with computer skills
which includes navigating multiple systems and keyboarding

Clinical Licensure:
Registered Nurse

Potential Telework Position:
No

Percent of Travel Required:
0 – 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate’s data privacy seriously. At no time will any Aetna
recruiter or employee request any financial or personal information (Social
Security Number, Credit card information for direct deposit, etc.) from you
via e-mail. Any requests for information will be discussed prior and will be
conducted through a secure website provided by the recruiter. Should you be
asked for such information, please notify us immediately.

Job Features

Job CategoryAdministration