UM Clinical Consultant

Employer: Aetna Inc.
Posted: 30-06-2020

Job Detail

Category: Health Care
Location: New Albany, OH

Job Description

Job Description

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.

Schedule is Monday-Friday standard business hours. After training their is a rotation of weekends on call and holidays.

Position is onsite in New Albany, OH.

EEO Statement

Aetna is an Equal Opportunity, Affirmative Action Employer

Fundamental Components

Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management functionGathers 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.

LICENSE REQUIRED

Registered Nurse (RN) with unrestricted state license.

Benefits Program

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.