Utilization Management Nurse Consultant - PST

Welcome to Aetna, where we believe in providing high-quality, affordable healthcare to all individuals. As a Utilization Management Nurse Consultant for our Pacific Standard Time (PST) region, you will play a vital role in ensuring that our members receive the best possible care while also controlling costs. We are seeking a highly skilled and compassionate individual with a strong clinical background and excellent communication and critical thinking skills. Join our team and make a positive impact on the healthcare industry while advancing your own career. Conduct utilization management activities for members in the Pacific Standard Time region, ensuring that high-quality and affordable healthcare services are provided. Utilize clinical knowledge and expertise to review and evaluate medical records, treatment plans, and other relevant information to determine appropriate levels of care. Review and approve or deny requests for medical services, procedures, and treatments based on established guidelines and protocols. Collaborate with healthcare providers, facilities, and other stakeholders to ensure appropriate and timely delivery of services. Communicate with members, providers, and other team members in a professional and empathetic manner to address questions, concerns, and provide education on utilization management processes and decisions. Monitor and track utilization data and trends to identify opportunities for improvement and cost-saving measures. Participate in team meetings and provide input on utilization management strategies and processes. Adhere to all regulatory and compliance requirements related to utilization management. Act as a liaison between Aetna and external stakeholders, such as providers and facilities, to facilitate effective utilization management processes. Continuously strive to improve clinical knowledge and skills through ongoing education and training opportunities. Maintain accurate and thorough documentation of utilization management activities and decisions. Collaborate with other departments within Aetna, such as claims and customer service, to ensure seamless delivery of services to members. Serve as an advocate for members by promoting a person-centered approach to healthcare and addressing any concerns or issues that may arise. Contribute to a positive and supportive team environment by actively participating in team-building activities and supporting colleagues. Represent Aetna in a professional and ethical manner at all times, upholding the company's values and mission. 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 tot his job Apply To this Job