Aetna Utilization Management Clinician - Behavioral Health in Boston, Massachusetts
Req ID: 55363BR
Please note: this position is full time work at home
This position is for a Utilization Management Clinician -BH, on the Autism Care Team. That individual will perform utilization management, precert as well as concurrent review within the Autism Care team for members receiving Applied Behavior Analysis (ABA) treatment/services for Autism. An active RN or Behavioral Health license to practice in the state in which you live is required.
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 precertification/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.
3+ years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility required
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer
Autism/ABA experience preferred
Managed care/utilization review experience preferred
Crisis intervention skills preferred
The minimum level of education desired for candidates in this position is a Master's degree OR Bachelor's degree for RN candidates
LICENSES AND CERTIFICATIONS
-Active unrestricted RN Licensure required
-Active Behavioral/Mental Health Licensure required (such as LPC, LCSW, LMFT)
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1+ Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1+ Years
Functional - Clinical / Medical/Precertification/1+ Years
Technical - Desktop Tools/Microsoft Outlook/1+ Years/End User
Technical - Desktop Tools/Microsoft Word/1+ Years/End User
Technical - Operating Systems/Windows/1+ Years/End 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
Full-Time Telework (WAH)
ADDITIONAL JOB INFORMATION
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 candidates'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
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.