Aetna UM Clinician - BH in Fresno, California

Req ID: 45371BR


This position is for a utilization management clinician. That individual will perform utilization management, precert as well as concurrent review within the Autism Care team for members receiving ABA treatment/services.

Fundamental Components:

Applies critical thinking and is knowledgeable of evidence-based treatment and clinical practice guidelines for Behavioral Health, specific to ABA. The majority of time is spent at a desk and on the telephone reviewing concurrent cases with the treating provider using specific criteria and making decisions to authorize additional services for our members or refer to a physician for a determination. Collaborates with providers/facilities to ensure appropriate planning to meet member needs

** Candidate will report into team located in Blue Bell, PA, however the candidate MUST reside in California


3-5 years of direct clinical practice experience post masters degree, e.g., hospital setting or setting such as ambulatory care or outpatient clinic/facility Managed care/utilization review experience preferred Crisis intervention skills preferred


The highest level of education desired for candidates in this position is a Master's degree if in a non nursing profession


One of the following CA certifications is required:

Mental Health/Licensed Clinical Social Worker Nursing/Registered Nurse (RN) is desired Mental Health/Licensed Professional Counselor Mental Health/Licensed Psychologist


Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years

Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years

FunctionalExperience/FunctionalFocus/1-3 Years


Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User

Technical - Desktop Tools/Microsoft Word/1-3 Years/Power User


Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Consulting for Solutions/ADVANCED


Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION


This is an opportunity to be part of a high performing dynamic team while enjoying the flexibility of working from home.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

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.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care