Precertification Nurse Consultant

Precertification Nurse Consultant

 

JOB RESPONSIBILITIES:
The Precertification Nurse Consultant utilizes clinical skills and experience to support comprehensive coordination of medical services including making initial coverage determinations, screening and referrals to Aetna Medical Services Programs. Promotes/supports quality effectiveness of Provider Service Centers. More specifically, precertification is the process of collecting information prior to inpatient admissions and performance of selected ambulatory procedures and services. The process permits advance eligibility verification, determination of coverage, and communication with the physician and/or member (precertification). In addition, identification of specialized programs such as Disease Management, Case Management, or our prenatal program allows proactive intervention to assist members in managing their medical needs. Precertification may either be done telephonically or electronically, through an Electronic Data Interchange (EDI) or Internet solution. Position requires collaboration between providers, members and Aetna clinical staff.

SKILL OR EXPERIENCE REQUIREMENTS:
A professional LVN or RN with an active, Texas state licensure. Experience: 3-5 years recent clinical experience. Additional experience in an alternative care setting such as home health helpful. Managed care or utilization management experience a bonus. Have proficient keyboarding skills and ability to use and navigate through multiple computer systems. This position also requires the ability to multitask with an emphasis on quality and productivity. Bilingual skills a plus.

ADDITIONAL JOB INFORMATION:
A high volume call center with service expectations and goals. Candidates must be comfortable being monitored for their level of efficiency, accuracy and customer satisfaction. The job is primarily sedentary work involving significant periods of sitting and data entry. An excellent opportunity to transition from care delivery into a business setting. A salaried non-exempt position based on a 40 hour work week Monday through Friday. The candidate is required to be on call 2-3 weekends per year to meet regulatory turn around times for decisions. In addition, flexible work schedules and a work at home program are available once the employee has been in the position one year and meets productivity and quality criteria. Dress is business casual. Covered parking is free.

 

HOW TO APPLY:

To learn more about our employment opportunities, visit us at www.aetna.com and enter Requisition #12812 on the job search page.

 

We conduct pre-employment drug and background testing.

No agencies, please.

Aetna is an equal opportunity/affirmative action employer.