Registered Nurse (RN) â€" Disability Nurse Reviewer
Location: South Portland Maine
Description: Aetna is employing Registered Nurse (RN) â€" Disability Nurse Reviewer right now, this position will be placed in Maine. More details about this position opportunity please read the description below. 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
The Nurse Reviewer utilizes clinical sk! ills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members enrolled in disease management programs. In Group Insurance, Nurse Reviewers are a clinical resource to their functional areas, with responsibilities that include the review of clinical records and communications with providers and other parties, to facilitate the clinical aspects of claim management and benefits determination process.
The Clinical Claim Review (CCR) process provides a clinical review to determine reimbursement for selected services. In addition the Nurse Reviewer acts as a clinical resource for the customer service and claims processing areas and the Special Investigations Unit staff.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Regis! tered Nurse (RN) is required.
FUNCTIONAL EXPERIENCES !
Functional - Clinical/Direct Patient Care/3-5 Years
Functional - Clinical/Disability Nursing/1-3 Years
Functional - Medical/Clinical Claim Review and Coding/1-3 Years
Functional - Utilization Review/Utilization Management/3-5 Years
Functional - Disability/Absence Management, Leave and Disability Products/1-3 Years
Functional - Nursing/Case Management/1-3 Years
TECHNOLOGY EXPERIENCES
Technical - Desktop Tools/Microsoft Outlook/1-3 Years
Technical - Desktop Tools/Microsoft Explorer/1-3 Years
Technical - Desktop Tools/Microsoft Word/1-3 Years
Technical - Aetna Applications/Workability Claim/1-3 Years
REQUIRED SKILLS
Benefits Management/Interacting with Medical Professionals
Benefits Management/Maximizing Healthcare Quality
General Business/Applying Reasoned Judgment
DESIRED SKILLS
Benefits Management/Supporting Medical Practice
General Business/Consulting for Solutions
Service/Providing ! Solutions to Constituent Needs
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
How to apply
Please use the "Apply" link to apply to this position. If you cannot view this link, you can find this position on our website by visiting: www.aetna.com/working, click on apply online, search openings, and enter 16160BR in the keyword field. Additional information on what it’s like to work for Aetna and more can also be found on our website.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Aetna is an Equal Opportunity/Affirmativ! e Action Employer. M/F/D/V
Aetna is committed to maintaining a! n environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.
No search firms please.
You will not be asked for personal information until you have been fully evaluated through Aetna's screening processes. Aetna will never ask applicants for money. If you want to verify the identity of someone who contacts you from Aetna, call 1-800-AETNAHR (1-800-238-6247).
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Aetna.
If you interested on this position just click o! n the Apply button, you will be redirected to the official website
This position starts available on: Wed, 26 Feb 2014 16:48:27 GMT
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