Utilization Management Nurse Consultant

Are you a highly motivated and skilled nurse looking for a challenging and rewarding career opportunity? Aetna is seeking a Utilization Management Nurse Consultant to join our dynamic team. In this role, you will have the opportunity to utilize your clinical expertise and critical thinking skills to help ensure the delivery of high-quality and cost-effective healthcare services for our members. If you are passionate about making a positive impact on the lives of others and have a strong background in utilization management, we want to hear from you! Join us in our mission to build healthier communities and make a difference in the healthcare industry.

Conduct utilization management activities to ensure the delivery of high-quality and cost-effective healthcare services for Aetna members.
Utilize clinical expertise and critical thinking skills to review and analyze medical information for appropriateness and necessity of services.
Collaborate with healthcare providers to develop and implement care plans that meet the needs of Aetna members.
Evaluate medical necessity and ensure compliance with evidence-based guidelines and Aetna policies.
Communicate with members, providers, and other healthcare professionals to facilitate the delivery of quality care.
Maintain accurate and thorough documentation of all utilization management activities.
Stay updated on industry trends and best practices in utilization management and apply them to daily responsibilities.
Provide education and support to members and providers on utilization management processes and procedures.
Participate in quality improvement initiatives to enhance the effectiveness and efficiency of utilization management.
Act as a resource for other team members and provide guidance and support as needed.
Adhere to all regulatory and compliance requirements.
Collaborate with other departments and teams to ensure a coordinated approach to patient care.
Help identify and implement process improvements to increase efficiency and effectiveness of utilization management.
Maintain confidentiality and handle sensitive information with professionalism and discretion.
Promote Aetna’s mission and values by delivering high-quality and compassionate healthcare services.

Aetna is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.