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		<title> Jobs at Aetna    </title>
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		<description> Jobs at Aetna    </description>
		<language>en-us</language>
		<copyright>Copyright (c) 2006 Jobvolume All rights reserved.</copyright>
		<lastBuildDate>Wed, 3 Dec 2008 03:29:48 GMT</lastBuildDate>

        
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                        <title><![CDATA[Nurse Consultant RN/LPN (On Site Review) at Aetna, (USA-DE-Newark)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=2076683419</link>
                        <guid isPermaLink="false">2076683419</guid>
                        <pubDate>Tue, 2 Dec 2008 11:17:47 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
JOB MISSION SUMMARY
The Nurse Consultant utilizes clinical skills 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. Examples of areas that will utilize this position description include: 
In Group Insurance, Nurse Consultants 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 Consultant acts as a clinical resource for the customer service and claims processing areas and the Special Investigations Unit staff. 
RESPONSIBILITIES
The Clinical Claim Review (CCR) process provides a clinical review to determine reimbursement for selected services. In addition the Nurse Consultant acts as a clinical resource for the customer service and claims processing areas.
Identification of Members/Services to be reviewed 
- Screen members to identify needed medical services, modifiable risk factors and educational needs in order to make appropriate referrals to other functional areas as needed 
- Intervenes to positively effect healthcare outcome 
- Review and authorize the required services in accordance with the benefit plan 
- Applies data driven methods of identification of members, and is accountable to follow appropriate procedures for identifying, screening and assessing member needs 
- Proactive and predictive identification and appropriate recommendations for referrals to alternative healthcare programs, e.g. disease management, case management, vocational rehabilitation 
- Conducts individualized clinical assessments of members&apos; care needs and develops a personalized chronic disease specific action plan to include approaches to meeting needs either through Aetna, the member&apos;s benefits plan or external programs and services 
- Problem solving when self-management skills fail to produce expected results 
Assessment of Medical Documentation 
- Promotes communication, both internal and externally to enhance effectiveness of medical management services (e.g., primary Care Physicians, treating physicians, claim administrators, Plan Sponsors, and third party payors as well as member, family, and health care team members respectively) 
- Applies care management concepts to complex issues and problem solving techniques in order to promote optimum patient outcomes 
- Reviews medical documents to make benefit determinations 
Enhancement of Medical Appropriateness   Quality of Care 
- Application and/or interpretation of appropriate clinical criteria and guidelines, standardized case management plans, policies, procedures and regulatory standards while assessing Member&apos;s needs to ensure appropriate administration of benefits and/or facilitate optimum outcome 
- Interprets relevant medical policy/benefits determination to an identified case 
- Advocates for patients to the full extent of existing health care or disability coverage and programs 
- Interprets clinical practice guidelines to reinforce appropriate self care teaching and monitoring 
- Determines when to consult primary care physician or to review case with Aetna Medical Director 
- Provides up-to-date health care information to help facilitate the member&apos;s understanding of his/her heath problem and possible options 
- Helps member actively and knowledgeably participate with their provider in their own health care decision making 
Monitoring, Evaluation and Documentation of Care 
- Maintaining compliance with various state and federal laws and regulations, URAQ and/or NCQA standards where applicable, while adhering to company policy and procedures 
- Evaluates, periodically, the member&apos;s progress in meeting plan goals, and revises and coordinates plan with attending physician accordingly when appropriate 
- Consults with supervisors and/or Medical Directors to overcome barriers to meeting plan goals and objectives; presents cases at Medical Director rounds and case conferences to obtain multidisciplinary review or to Medical Director directly as appropriate 
- Consult with medical directors to clarify application of clinical practice guidelines to program guidelines 
- Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements 
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality 
- Serves as primary clinical linkage to and with disease management vendors 
Sedentary work involving significant periods of sitting, talking, hearing and keying. Work requires visual acuity to perform close inspection of written and computer generated documents as well as a PC monitor. Working environment includes typical office conditions 
Drivers license and reliable transportation required for travel for some Nurse positions 
This position is a tele work position. Travel to acute care facilities is required. Medical claims review knowledge is required.
REQUIRED SKILLS
- 5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care. 
- 2 years managed care case management and/or utilization management experience. 
- 2 years experience in Group Insurance, Clinical Case Management, Utilization Review, Disability, Behavioral Health or Disease Management. 
- RN with current unrestricted state licensure. 
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company.
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[Account Executive at Aetna, (USA-OH-New Albany)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=782981366</link>
                        <guid isPermaLink="false">782981366</guid>
                        <pubDate>Tue, 2 Dec 2008 11:17:21 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
These are the professionals who help us build our business in the national accounts, middle markets, small group markets, distribution channel, group insurance and specialty products areas. Their goal is to meet customer needs and help them make better decisions and about their health care and health care spending. 
EDUCATION 
The highest level of education desired for candidates in this position is a Bachelor&apos;s degree or equivalent experience. 
LICENSES AND CERTIFICATIONS 
- Health, Life and Variable Annuities is required 
FUNCTIONAL WORK EXPERIENCES 
- Sales   Service: Account Management 
- Project Management: Project Management 
- Sales: Strategy development 
REQUIRED SKILLS 
- Consultative Solutions Selling 
- Develop effective relationships with plan sponsors 
- Ensuring Ethical Decisions 
- Negotiating Collaboratively 
- Organize meetings, functions and activities which enhance plan sponsor relationships 
- Prepare management information reports and presentations 
DESIRED SKILLS 
- Utilize knowledge of competition and competitive positioning to evaluate risk and maximize profitability 
- Turning Data into Information 
- Shape benefits designs to accurately reflect profit and risk in pricing 
POSITION SUMMARY 
Previous Account Executive experience with national account customers is preferable with a minimum of six years insurance/health care experience. Applicant should possess the ability to interface with senior management with this customer and consultants. Through complex negotiations, strong influencing skills and in-depth knowledge of our products and services, the successful candidate will initiate actions which maximize revenue, retain and grow the client relationship, and effectively position our products with an emphasis on expanding their assigned book of business. Identify various ways to partner with clients by drawing from Aetna s full spectrum of product lines illustrating a keen understanding of the client s multifaceted needs; Demonstrate thorough understanding of client s and Aetna s financial and operational objectives. 
Account Executive will also provide guidance, support, and strategic leadership among the service team assigned to their plan sponsor. It is critical that this person be able to work with various cross-organizational departments to meet the needs of the customer. Demonstrate necessary interpersonal communication skills and flexibility to appropriately influence others from an internal and external perspective. Strong presentation skills and the ability to communicate in writing are required. The candidate should possess the ability to coordinate projects and meet deadlines.
ADDITIONAL JOB INFORMATION 
Aetna is dedicated to helping people achieve health and financial security. This position deals directly with one of Aetna&apos;s largest customers. This customer has become part of the Aetna family over the years. The focus on this customer is unparalleled service! It is a highly visible customer within Aetna and the central Ohio business community. 
Must have valid driver&apos;s license.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[STD Intake Claim Analyst at Aetna, (USA-FL-Plantation)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=4020130684</link>
                        <guid isPermaLink="false">4020130684</guid>
                        <pubDate>Tue, 2 Dec 2008 11:16:52 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
Fast, accurate claims payment is one of the ways we make a difference in people&apos;s lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it&apos;s most needed. 
EDUCATION 
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience. 
REQUIRED SKILLS 
- Demonstrating Service Discipline 
- Verbal Communication 
POSITION SUMMARY 
Claim Intake on all new UPS STD claims. Customer service on issues related to open and closed claims, observing performance guarantees within a call center environment, assisting with other administrated duties. 
ADDITIONAL JOB INFORMATION 
High School or equivalent, PC skills, prior customer service/call center operations experience, excellent customer service skills. Knowledge of email/MS Office/Excel. Must be Bilingual (English/Spanish) as Spanish is strongly preferred. This is a job with a daily work schedule of Monday-Friday, 11:30am - 8:00pm 
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[Care Management Associate at Aetna, (USA-AZ-Phoenix)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=1066148735</link>
                        <guid isPermaLink="false">1066148735</guid>
                        <pubDate>Mon, 1 Dec 2008 03:31:37 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge. 
EDUCATION 
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience. 
FUNCTIONAL WORK EXPERIENCES 
- Office Support: Data Entry 
REQUIRED SKILLS 
- All Aetna Standard Plans 
- Microsoft Outlook 
- Microsoft Word 
- Verify member coverage and ensure accuracy of member information 
- Leveraging Technology 
DESIRED SKILLS 
- Interpersonal Communication 
- Listening 
POSITION SUMMARY 
Support comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness of Healthcare Services. 
ADDITIONAL JOB INFORMATION 
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[Vocational Rehab Consultant at Aetna, (USA-NC-High Point)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=1962425437</link>
                        <guid isPermaLink="false">1962425437</guid>
                        <pubDate>Mon, 1 Dec 2008 03:31:25 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
Fast, accurate claims payment is one of the ways we make a difference in people&apos;s lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it&apos;s most needed. 
EDUCATION 
The highest level of education desired for candidates in this position is a Master&apos;s degree. 
REQUIRED SKILLS 
- Assess risk and make sound decisions based on established criteria 
- Collaborating for Results 
- Long Term Disability (Traditional) 
- Verbal Communication 
- Working Across Boundaries 
- Delivering Profit and Performance 
POSITION SUMMARY 
Ability to manage a changing caseload and provide quality services that meet Department service standards. Verbally communicates with potential rehabilitation candidates with varied disabilities on a nationwide basis   provides vocational direction by evaluating, initiating   coordinating rehabilitation plans. Contracts with private rehabilitation vendors and monitors and directs their rehabilitation plans   billing. Provides product support to Claim, Marketing, Underwriting, and Accounting. Participates in sales presentations to explain rehabilitation program as needed. Travel may be required on occasion. Must be able to persuasively communicate verbally with STD/LTD associates,customers and providers to affect a positive rehabilitation outcome. Understands group STD/LTD policies and contracts and is able to utilize company resources as they relate to rehabilitation plan development. Must understand the rehab hierarchy. Must have working medical knowledge, and ability to analyze functional assessments, vocational evaluations, Job Analyses, TSA&apos;s and LMS&apos;s. Ability to negotiate with associates, employers, and medical providers to enlist their support in development of return to work plans. Works very closely with other members of disability claim team nurses and disability analysts to achieve common goals and results. 
ADDITIONAL JOB INFORMATION 
Select appropriate rehabilitation cases and provide cost effective case management which results in the successful termination of disability claims and achieve benefit savings for STD/LTD customer.
Masters degree with a specialization in Vocational Rehabilitation or in a related field a minimum of three to five years experience in vocational counseling managing an insurance disability and or Workers Compensation caseload and one or more professional certifications: CRC, CDMS, CCM, CVE are desired. Strong verbal and written communication skills required. Computer experience especially with Windows based programs helpful. Must have strong interpersonal skills a persuasive manner and the ability to deal diplomatically in sensitive situations. 
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[Pharmacy Technician at Aetna, (USA-AZ-Phoenix)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=3648717694</link>
                        <guid isPermaLink="false">3648717694</guid>
                        <pubDate>Mon, 1 Dec 2008 03:31:09 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge. 
EDUCATION 
The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience. 
LICENSES AND CERTIFICATIONS 
- Pharmacy Technician is required 
FUNCTIONAL WORK EXPERIENCE 
- Clinical / Medical: Clinical coverage   policies 
- Medical Management: Medical Management - Pharmacy 
REQUIRED SKILLS 
- Analyze and research requests for member PHI in accordance with HIPAA Call Handling procedures 
- Authorize and coordinate required services in accordance with the benefit plan 
- Customer Service Inquiry 
- Interacting with Medical Professionals 
- Microsoft Outlook 
- Perform intake calls from members 
POSITION SUMMARY 
Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs. Promotes/supports quality effectiveness of Healthcare Services. 
ADDITIONAL JOB INFORMATION 
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[Disease Management Supervisor at Aetna, (USA-AZ-Phoenix)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=3669409490</link>
                        <guid isPermaLink="false">3669409490</guid>
                        <pubDate>Sat, 29 Nov 2008 21:34:15 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge. 
EDUCATION 
The highest level of education desired for candidates in this position is a Bachelor&apos;s degree or equivalent experience. 
LICENSES AND CERTIFICATIONS 
- Registered Nurse (RN) is required 
FUNCTIONAL WORK EXPERIENCE 
- Management: Management Health Care Delivery 
- Leadership: Lead a major change effort culture change 
REQUIRED SKILLS 
- Assess and manage volume of work against planned resources 
- Deal decisively with performance problems 
- Effectively manage the nuances of diverse teams 
- Leveraging Technology 
- Interpersonal Communication 
- Monitor employee performance 
DESIRED SKILLS 
- Handling Service Challenges 
- Knowing Products and Services 
- Maintains compliance with risk, regulatory and accrediation requirements 
- Understanding Clinical Impacts 
- Assess qualifications of candidates 
- Manage employee relations issues 
POSITION SUMMARY 
The Supervisor is responsible for management of medical services staff including the organization and development of high performing teams. Works closely with managers (re: Case/Disease Management) ensuring consistency in care management interventions across membership. Facilitates effective interfaces among team members, as well as across teams, providers and Aetna departments. Responsible for the day-to-day implementation of Aetna&apos;s medical management services policies and procedures. Accountable for meeting the financial, operational and quality objectives of the unit.
ADDITIONAL JOB INFORMATION 
Oversees the implementation of Aetna medical management services including but not limited to Inpatient Care Coordination/Discharge Planning/Case Management/Disease Management/ and monitors daily performance to ensure business goals are met and compliance with Aetna policies and procedures is maintained Implements clinical policies   procedures in accordance with NCQA. Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking. Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring, evaluating and documenting of care.Communicates productivity expectations, balance workload (e.g., daily team meetings to discuss new referrals), monitor efficiency and initiate control measures to minimize variances in workload over time.Ensures the team&apos;s understanding and use of information system capability and functionality. May have responsibility for their own case load work. Select staff using clearly defined requirements in terms of education, experience, technical and performance skills. Assesses developmental needs and collaborates with others to identify and implement action plans that support the development of high performing teams. Establish an environment and work style that promotes the concept of teamwork, cross product integration, and continuum of care thinking that results in strong performance.Articulate performance expectations and team objectives while collecting and interpreting balanced measure to evaluate individual staff and team performance. Lead change efforts while managing transitions within a team. Create a positive work environment by acknowledging team (*)contributions, soliciting input, and offering personal assistance, when needed. Accountable for maintaining compliance with Human Resource policies and procedures and implements them at the employee level. Sedentary work involving periods of sitting, talking, hearing, work requires visual acuity to perform close inspection of hand written and computer generated documents. Typical office working environment. Exhibits behaviors outlined in Care Mangement Nurse Supervisor Competencies3-5 years clinical experience. Management experience in a clinical setting desired. Must have ability to obtain RN licensure without restrictions in any of the 50 United States.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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                        <title><![CDATA[Precertification Nurse Consultant - RN at Aetna, (USA-NH-Concord)]]></title>
                        <link>http://www.jobvolume.com/jobid.jsp?jkey=3102253498</link>
                        <guid isPermaLink="false">3102253498</guid>
                        <pubDate>Sat, 29 Nov 2008 21:33:52 GMT</pubDate>
                        <description><![CDATA[Careers at Aetna Working at Aetna Job Search Search Aetna Jobs Opportunities for Experienced Professionals Opportunities for Students and Recent Graduates
ABOUT OUR COMPANY 
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. 
JOB GROUP SUMMARY 
The dedication of talented and caring health care professionals drives the delivery of high quality, cost effective products and services. They make it possible for members to get the right health care treatment for their needs and for Aetna to keep its competitive edge. 
EDUCATION 
The highest level of education desired for candidates in this position is a Associate&apos;s degree or equivalent experience. 
LICENSES AND CERTIFICATIONS 
- Registered Nurse (RN) is preferred 
- Licensed Practical Nurse (LPN) is required 
FUNCTIONAL WORK EXPERIENCE 
- Clinical / Medical: Precertification 
- Clinical / Medical: Clinical coverage   policies 
- Office Support: Data Entry 
REQUIRED SKILLS 
- Assess members clinical care needs 
- Apply clinical criteria and guidelines to ensure appropriate administration of benefits and optimum medical outcomes 
- Communicate to enhance effectiveness of medical management services (i.e. plan sponsors, claim administrators, physicians, members, family and health care team) 
- Consult with Medical Directors on cases that don t meet coverage policy bulletin or clinical criteria guidelines 
- Interacting with Medical Professionals 
- Perform intake calls from providers 
DESIRED SKILLS 
- Microsoft Outlook 
- Review and evaluate clinical history to identify needed medical services 
- Research and resolve claim payment issues 
POSITION SUMMARY 
The Nurse utilizes clinical skills 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 Healthcare Services.
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). It also allows Aetna to coordinate the patient&apos;s transition from the inpatient setting to the next level of care (discharge planning), or to refer patients for specialized programs such as Disease Management, Case Management, or our prenatal program. Precertification may either be done telephonically or electronically, through an Electronic Data Interchange (EDI) or Internet solution. There are two components of Precertification: Notification and medical review. 
ADDITIONAL JOB INFORMATION 
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with our company. 
Please note that benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Equal Opportunity and Affirmative Action
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna&apos;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.
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