Utilization Management Nurse Consultant

Are you a highly skilled and compassionate nurse looking for a rewarding career opportunity? Aetna, a leading healthcare company, is seeking a Utilization Management Nurse Consultant to join our team. In this role, you will have the chance to make a positive impact on the lives of our members by ensuring they receive the best and most effective care. We are seeking a motivated individual with a strong clinical background, excellent communication skills, and a passion for improving healthcare outcomes. If you are ready to take on a challenging and fulfilling role, we encourage you to apply today.

Conduct utilization management reviews to ensure appropriate and cost-effective care for Aetna members.
Utilize clinical knowledge and expertise to evaluate medical records and treatment plans for accuracy and effectiveness.
Collaborate with healthcare providers to develop and implement care plans that meet the needs of Aetna members.
Communicate with members and providers to clarify and explain utilization management decisions.
Monitor and track utilization management data to identify trends and opportunities for improvement.
Stay up-to-date on industry regulations and best practices related to utilization management.
Serve as a resource and mentor for other members of the utilization management team.
Participate in quality improvement initiatives to enhance the effectiveness of utilization management processes.
Advocate for the needs of Aetna members and ensure they receive high-quality, compassionate care.
Maintain accurate and detailed documentation of utilization management activities.
Collaborate with other departments and teams within Aetna to support overall company goals and objectives.
Continuously seek opportunities to enhance and streamline utilization management processes.
Prioritize and manage a high volume of cases while maintaining quality and accuracy.
Act as a liaison between Aetna, members, and healthcare providers to ensure seamless coordination of care.
Demonstrate professionalism, empathy, and compassion in all interactions with members and providers.

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.

Apply Job!