Utilization Management Registered Nurse Consultant
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Schedule is Monday-Friday standard business hours. No nights! Rotation weekend/holidays as needed. Remote role, however must reside 1 hour or less commute to the Downer's Grove, IL Aetna office. Fundamental Components 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 Apply tot his job