Concurrent Review Nurse, Rn (telework In Ct)
Aetna (Hartford, Connecticut)

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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.

Mission 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.

Job Responsibilities

-Reviews member’s facility medical records and conducts concurrent review to assess the appropriateness of facility based care, including abstracting appropriate clinical information; can be completed telephonically or in the facilities
-Evaluates for the appropriate level or location of care and anticipated length of stay.
-Communicates with the Chief Medical Director or designee, as necessary, to support the concurrent review functions and processes
-Communicates with the attending and or primary care physicians on an on-going basis
-Communicates with hospital case managers, discharge planners and other facility staff on an ongoing basis
-Participates in member conferences, family conferences and regular staffing for inpatient admissions
-Functions as liaison and problem solver for all Concurrent Review related issues
-Gathers and reports recipient data, including quality and utilization indicator information and other applicable information
-Maintains confidentiality of the member s medical information
Identifies and refers members to care management to assist the member in accessing appropriate health care and community services
-Meets with members and families to explain benefits and treatment planning, as applicable

Secondary Functions:
-Conducts provider and support system education on a routine basis
-Refers cases of possible quality deviation to the Quality Management Department
-Refers cases of possible over/under utilization to the Chief Medical Director


Required Skills:
-Registered Nurse (Bachelor s or Associate degree) with current, unrestricted Connecticut `RN license
-Minimum of three years clinical/hospital nursing experience, such as ICU, medical/surgical, OB/maternity, etc.
-Minimum of one year of experience in Managed Care and/or three (3) years experience in UR/UM Concurrent Review experience preferred.
-Understanding of the MILLIMAN Care Guidelines preferred
-Effective written and oral communication skills to include presentations and training before small and large groups.
-Effective problem solving, organizational skills and time management skills with the ability to work in a fast paced environment.
-Proficiency with Microsoft Office Suite applications and common computer and office hardware.
-Reliable transportation with appropriate insurance.
-Ability to work independently with minimal supervision.



Additional Information

This is a teleworking position which needs to reside in CT due to on-site responsibilities at the hospitals to complete discharge planning.


We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.

How to apply

To learn more about this opportunity, visit us at www.aetna.com/working . Under requisition # select 24335 and submit your resume.

We conduct pre-employment drug and background testing. No agencies, please.

Aetna is an equal opportunity/affirmative action employer