Aetna Licensed Concurrent Review Consultant - RN/LCSW/LPC/LMFT (VA MCD) in Virginia Beach, Virginia

Req ID: 39553BR

POSITION SUMMARY

The Concurrent Review Consultant utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.

Fundamental components include, but are not limited to:

  • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

  • Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care.

  • Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support).

  • Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.

  • Identifies members who may benefit from care management programs and facilitates referral.

  • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

    Qualification Requirements:

  • Minimum 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.

  • RN with unrestricted VA state license or Licensed independent behavioral health clinician (e.g. LCSW, LPC, LMFT, PhD, or Psy.D) with VA state license required.

  • Proficiency with MS Office suite required.

    Preferred Skills:

  • Managed care/utilization review experience strongly preferred.

    Education:

    The minimum level of education preferred for candidates in this position is a Bachelor's degree or equivalent experience.

    ADDITIONAL JOB INFORMATION

    Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Virginia is looking for people like you who value excellence, integrity, caring and innovation. As an employee, youll join a team dedicated to improving the lives of Virginia Medicaid Long Term Services and Supports members. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Virginia, and we will support you all the way

    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