Aetna Utilization Management Clinician - Behavioral Health in Rancho Cucamonga, California

Req ID: 40904BR

This is a work at home position. The required hours are Monday-Friday 12pm-8:30pm EST.

One of the following licenses is required: LCSW, LPC, LMHC, or RN. Candidates with a California license are highly preferred.


Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.

Fundamental components include but are not limited to:

Ability to assess needs for treatment of chemical dependency and mental health issues, including appropriate level of care required. Ability to document clinical information concisely and clearly. Ability to synthesized clinical data and make appropriate recommendations to Medical Directors. Ability to interact professionally with a wide range of providers and utilization management staff.


-3-5 years of direct clinical practice experience post masters degree, e.g., Alternative care setting such as inpatient or outpatient clinic/facility is required

-Precertification/1-3 Years is required

-Managed care/utilization review experience preferred.

-Strong Clinical/Crisis intervention skills are required

-Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding


The minimum level of education desired for candidates in this position is a Master's degree.


One of the licenses below is required:

Licensed Clinical Social Worker

Licensed Mental Health Counselor

Licensed Professional Counselor

Registered Nurse (RN)


Medical/Precertification/1-3 Years

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

Mental Health/1-3 Years


Technical - Aetna Applications/Aetna Behavioral Health

Technical - Desktop Tools/Microsoft Outlook

Technical - Desktop Tools/Microsoft Word


Benefits Management/Understanding Clinical Impacts

General Business/Consulting for Solutions

Leadership/Collaborating for Results


Benefits Management/Interacting with Medical Professional

Leadership/Driving a Culture of Compliance

Leadership/Fostering a Global Perspective

Telework Specifications:

Considered for any US location; training period in the office may be required


This position will be part of the Behavioral Health Precertification team who reviews Autism care requests. This position will allow for telework unless you are within commuting distance to an Aetna office. Below are the responsibilities for this position: - Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate. - Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members - Provides triage and crisis support - Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care - Coordinates with providers and other parties to facilitate optimal care/treatment - Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs - Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization - Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Education and Certification Requirements Licensed. Please note that the work hour expectation is 12 - 8:30pm et.

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