RN Process Associate

Danbury, Connecticut | Direct Hire

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Job description:

  • Managing incoming calls (high call flow environment)
  • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests
  • Refers cases requiring clinical review to a Nurse reviewer
  • Responsible for the identification and data entry of referral requests into the UM system
  • Responds to telephone and written inquiries from clients, providers and Aetna’s internal departments
  • Checks benefits for facility-based treatment
  • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.

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