Utilization Management Nurse Associate (LPN/LVN)

Mô tả công việc

Working At Aetna -- the Value To YouWhat does it mean to work at Aetna? A lot.  From programs and benefits that support your financial, physical and emotional health to opportunities to build your knowledge and expand your career, the company makes working here a valuable experience in many ways. POSITION SUMMARY Utilizes clinical skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. Proficient computer skills with Microsoft office and Outlook. Excellent verbal and written communication skills. Works well in team settings as well as independently. Good decision making skills - Promotes/supports quality effectiveness of Healthcare Services and benefit utilization - Utilizes clinical skills to support coordination, documentation and communication of medical services and/or benefit administration - Collects information to support the process of rendering appropriate medical necessity/benefit determinations - Identifies members for referral opportunities to integrate with other products, services and/or programs - Utilizes clinical experience, criteria/guidelines, policies and procedures in support of making timely and accurate medical necessity/benefit determinations This is an excellent opportunity for a motivated self-starter who can work independently within a cohesive team environment. The key candidate will: Adhere to quality standards and guidelines Approach work in an organized and systematic manner Manage basic tasks in a timely manner using appropriate tools and systems Maintain focus on quality in completing internal processes correctly and efficiently Identify issues and solve problems Effectively access relevant information Act ethically and with integrity Honor commitments and keep promises Adhere to all applicable laws and regulations Raise problems and concerns in a timely manner Hold self and others accountable