Utilization Management Registered Nurse Consultant

Job Description
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

Background Experience
3 years of clinical nursing experience required (med surg)
Managed Care experience preferred

LICENSE
Requires an RN with unrestricted active State of Illinois license.

EDUCATION
BSN 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.

Education
Bachelor's degree or equivalent experience

Percent of Travel Required
0 - 10%