Licensed Medicare Appeals Nurse Consultant job at Aetna in Boise

Aetna is employing Licensed Medicare Appeals Nurse Consultant on Wed, 07 Aug 2013 12:06:31 GMT. Req ID: 12688BR This is a telework role, but candidates must live within commuting distance of an Aetna office. All external candidates must have an active RN license in the state in which they reside.POSITION SUMMARYThe Medicare Clinical Appeal Team (MCAT) is part of the National Clinical Appeal Unit, and is charged with the clinical review of Aetna Medicare Advantage Plan members. MCAT nurses...

Licensed Medicare Appeals Nurse Consultant

Location: Boise, Idaho

Description: Aetna is employing Licensed Medicare Appeals Nurse Consultant right now, this job will be designated in Idaho. For detail informations about this job opportunity kindly see the descriptions. Req ID: 12688BR

This is a telework role, but candidates must live within commuting distance of an Aetna office. All external candidates must have an active RN license in the st! ate in which they reside.POSITION SUMMARYThe Medicare Clinical Appeal Team (MCAT) is part of the National Clinical Appeal Unit, and is charged with the clinical review of Aetna Medicare Advantage Plan members. MCAT nurses and pharmacists work closely with the Medicare Grievance and Appeal Unit (MGAU), providing timely clinical reviews on a diverse range of clinical topics. Each team members work is directly linked to the success of Aetna's Medicare Star Quality Rating system. The MCAT values positive teamwork, independent thinking, problem solving skills, and drive for excellence.Responsible for the review and resolution of clinical documentation, clinical complaints and appeals of Medicare Advantage Plan members. Reviews documentation and interprets data obtained from clinical records to apply appropriate Medicare - Centers for Medicare & Medicaid Services (CMS) clinical criteria and policies in line with regulatory and accreditation requirements for member and provider is! sues. Independently coordinates the clinical resolution with i! nternal/external clinician support as required. Requires an RN with unrestricted active license.EDUCATIONThe minimum level of education required for candidates in this position is a High School diploma, G.E.D. or equivalent experience.LICENSES AND CERTIFICATIONSNursing/Registered Nurse (RN), Nursing/Licensed Practical Nurse (LPN), or Nursing/Licensed Vocational Nurse (LVN) is required.FUNCTIONAL EXPERIENCESFunctional - Nursing/Medical-Surgical Care/1-3 YearsFunctional - Nursing/Clinical Claim Review and Coding/1-3 YearsFunctional - Clinical/Medical/Concurrent Review/Discharge Planning/1-3 YearsREQUIRED SKILLSBenefits Management/Interacting with Medical ProfessionalsBenefits Management/Understanding Clinical ImpactsLeadership/Driving a Culture of ComplianceDESIRED SKILLSLeadership/Fostering a Global PerspectiveService/Creating a Differentiated Service ExperienceTechnology/Leveraging TechnologyPlease note that benefit eligibility may vary by position. Clickhereto review the b! enefits associated with this position.

Aetna does not permit the use of tobacco related products or drugs in the workplace.

Job Function: Health Care
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If you were eligible to this job, please send us your resume, with salary requirements and a resume to Aetna.

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This job starts available on: Wed, 07 Aug 2013 12:06:31 GMT



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