Aetna UM Clinical Consultant (RN, LCPC, LSCSW, LCP, LCMFT, LCAC) - KS MCD in Overland Park, Kansas

Req ID: 51758BR

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

POSITION SUMMARY

The UM Clinical 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. This position may perform Concurrent Review and/or Prior Authorization job duties.

Fundamental Components:

  • 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.

  • Typical office working environment with productivity and quality expectations.

  • Work requires sitting for extended periods, talking on the telephone and typing on the computer.

  • Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.

  • Works and provides coverage on weekends and holidays, as assigned.

    Qualification Requirements:

  • Minimum of 3-5 years clinical practice experience, e.g., hospital setting, LTSS, alternative care setting such as home health or ambulatory care is required. -RN with active and unencumbered KS license (BSN preferred) OR a Master s level Behavioral Health professional independently licensed in KS (e.g., LSCSW, LCP, LCPC, LCMFT, LCAC) is required.

  • Proficiency with computer skills, which includes the Microsoft Office suite, navigating multiple systems and keyboarding is required.

  • Experience and knowledge required in clinical guidelines, systems/tools i.e., Milliman, Interqual. LCDs/MCSs, LOCUS, CASII, ASAM

  • Strong documentation skills and broad based clinical knowledge is required.

  • Ability to work and provide coverage on weekends and holidays, as assigned, is required.

  • Self-motivated and confident making clinical decisions; ability to influence and shape clinical outcomes.

  • Strong organizational skills with an attention to detail.

  • Ability to work independently and on a team.

  • Ability to work with all levels of management.

  • Managed care/utilization review experience strongly preferred.

  • Knowledge of provider networks and delivery; ability to interface with providers strongly preferred.

  • Behavioral Health and physical health integrated care experience preferred.

    Education:

    The minimum level of education required for candidates in this position is an Associate's degree or equivalent experience.

    Licenses:

    At least ONE of the following is required (active and unrestricted for the State of KS):- Registered Nurse (RN) License

  • Licensed Specialist Clinical Social Worker (LSCSW)

  • Licensed Clinical Professional Counselor (LCPC)- Licensed Clinical Psychologist (LCP)- Licensed Clinical Marriage and Family Therapist (LCMFT)- Licensed Clinical Addiction Counselor (LCAC)

    FUNCTIONAL EXPERIENCES

    Functional - Medical Management/Medical Management - Concurrent Review/4-6 Years

    Functional - Medical Management/Medical Management - Prior Authorization/4-6 Years

    Functional - Clinical / Medical/ Concurrent review / Discharge Planning/4-6 Years

    Functional - Medical Management/Medical Management - Direct patient care/4-6 Years

    Functional - Medical Management/Medical Management - Discharge planning/4-6 Years

    TECHNOLOGY EXPERIENCES

    Technical - Desktop Tools/Microsoft Word/4-6 Years/End User

    Technical - Desktop Tools/TE Microsoft Excel/4-6 Years/End User

    Technical - Desktop Tools/Microsoft Outlook/4-6 Years/End User

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

    ADDITIONAL JOB INFORMATION

    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