Utilization Management Nurse Consultant

Welcome to Aetna, a leading healthcare company that is dedicated to improving the quality of life for our members. We are seeking a highly skilled and compassionate Utilization Management Nurse Consultant to join our team. In this role, you will be responsible for ensuring the appropriate utilization of healthcare services and resources for our members, while also advocating for their best interests. If you are a self-motivated and detail-oriented nurse with a passion for making a difference in people's lives, we want to hear from you. Join us in our mission to provide high-quality, cost-effective healthcare solutions and help us shape the future of healthcare. Conduct utilization review and management for Aetna members, ensuring the appropriate utilization of healthcare services and resources. Collaborate with healthcare providers and Aetna team members to develop and implement care plans that meet the individual needs of our members. Advocate for the best interests of our members by identifying and addressing any barriers to care. Utilize clinical knowledge and expertise to evaluate medical necessity and appropriateness of requested services. Monitor and analyze healthcare utilization data to identify trends and potential areas for improvement. Maintain accurate and detailed documentation of all utilization management activities. Communicate and collaborate effectively with members, providers, and other Aetna team members to ensure the best possible outcomes for our members. Stay up-to-date on industry trends and changes in healthcare policies and regulations. Participate in quality improvement initiatives and provide recommendations for improving processes and programs. Promote Aetna's mission and values by providing exceptional customer service and demonstrating a commitment to improving the quality of life for our members. 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.