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Registered Nurse

Company: Aetna
Location: Aliso Viejo
Posted on: September 13, 2020

Job Description:

Req ID: 72337BR Job Description Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license. Fundamental Components included but are not limited to: Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services, and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Qualifications Requirements and Preferences: 3+ years of clinical experience required Post-acute experience preferred RN with current unrestricted state licensure required Managed care experience preferred 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 keyboardingEffective communication skills, both verbal and written. Benefit Eligibility Benefit eligibility may vary by position. Job Function: HealthcareAetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

Keywords: Aetna, Aliso Viejo , Registered Nurse, Healthcare , Aliso Viejo, California

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