CCR Nurse Consultant
Aetna - Allentown, PA

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Telework opportunities are for internal candidates who have been employed by Aetna for one year or greater. External candidates may be evaluated for telework eligibility after one year of employment at Aetna.
POSITION SUMMARY
Responsible for the review and evaluation of clinical information and documentation. Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Independently coordinates the clinical resolution with internal/external clinician support as required. Requires an RN with unrestricted active license.
EDUCATION
The highest level of education desired for candidates in this position is a Bachelor''s degree or equivalent experience.
LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required
FUNCTIONAL EXPERIENCES
Nursing/Medical-Surgical Care/4-6 Years
Clinical / Medical/Clinical claim review & coding/1-3 Years
TECHNOLOGY EXPERIENCES
Aetna Applications/eTUMS -Total Utilization Mgmt System Internet/1-3 Years/End User
Aetna Applications/Aetna Total clinical View/1-3 Years/End User
Aetna Applications/Electronic Correspondence Handling System/1-3 Years/End User
REQUIRED SKILLS
Benefits Management/Understanding Clinical Impacts/ADVANCED
General Business/Applying Reasoned Judgment/ADVANCED
Leadership/Fostering a Global Perspective/FOUNDATION
DESIRED SKILLS
Technology/Leveraging Technology/FOUNDATION
Benefits Management/Interacting with Medical Professionals/ADVANCED
ADDITIONAL JOB INFORMATION
Clinical Claim Review is looking to add to their team of clinicians.

Please note that benefit eligibility may vary by position.Clickhereto review the benefits associated with this position.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Job Function: Health Care
Job Function: Health Care

Aetna - 18 months ago - save job - block
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