Concurrent Review Nurse

Are you passionate about providing quality healthcare to patients while also driving cost-effective, efficient care? Aetna is seeking a dedicated and experienced Concurrent Review Nurse to join our team. In this role, you will play a crucial part in ensuring our members receive the appropriate level of care at the right time. As a Concurrent Review Nurse, you will utilize your clinical expertise and critical thinking skills to evaluate medical records and collaborate with healthcare providers to determine the most appropriate and cost-effective treatment plans. Join us in our mission to improve the health and well-being of our members while also promoting sustainable healthcare costs. To excel in this role, you must have a current nursing license and at least 3 years of clinical experience. Additionally, a strong understanding of medical terminology, coding, and utilization management is required. We are looking for someone who is a strong communicator, able to build relationships with providers and colleagues, and can work independently in a fast-paced environment. If you are a compassionate and dedicated healthcare professional looking to make a difference, we encourage you to apply for this exciting opportunity at Aetna. Evaluate medical records and collaborate with healthcare providers to determine the appropriate level of care for patients. Utilize clinical expertise and critical thinking skills to identify cost-effective treatment plans. Conduct concurrent reviews of patient cases to ensure appropriate and timely care. Communicate with healthcare providers to obtain necessary information and clarify treatment plans. Maintain knowledge of medical terminology, coding, and utilization management to accurately assess patient needs. Adhere to company policies and procedures, as well as state and federal regulations, in all aspects of work. Document all review activities and decisions accurately and in a timely manner. Build and maintain relationships with healthcare providers and colleagues to facilitate effective collaboration. Work independently and efficiently in a fast-paced environment while meeting productivity and quality goals. Stay up-to-date on industry developments, trends, and best practices related to healthcare delivery and cost management. Advocate for the health and well-being of members by promoting sustainable healthcare costs. Ensure compliance with all patient confidentiality and privacy regulations. Participate in training and development activities to continuously enhance knowledge and skills. Provide excellent customer service to members and healthcare providers. Represent Aetna in a professional and ethical manner at all times. 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