Aetna Veterans Jobs

Job Information

Aetna Business Consultant - Utilization Management- Behavioral Health (60078BR) in Phoenix, Arizona

Req ID: 60078BR

Job Description

Medicaid UM Shared Services staff are involved in managing standard operating practices, partner with local plan markets on new and existing initiatives.

Fundamental Components included but are not limited to:

Supports holistic solutions and/or key strategic plans. Proactively identifies opportunities for improvement within assigned initiatives

Conducts thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., outsourcing, process improvements, technology solutions)

Participates in influencing client contracting process, builds optimal client relationship for results and deliverables and manages relationship throughout engagement

Participates and supports metrics integration and execution for optimal results. Shares joint accountability for initiative s return on investment

Communicates compelling and concise results to empower client groups in decision making process regarding project opportunities

Participates in initiative planning as required. Supports engagement using a disciplined repeatable methodology

Designs, develops interventions and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials

Gathers, analyzes and synthesizes business intelligence to drive achievement of strategic business objectives

Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer

Qualifications Requirements and Preferences:

Behavioral Health Inpatient treatment setting in last 5 years

Behavioral Health UM experience including Program Development within UM

Health Plan Leadership

Process Driven with prior authorization and concurrent review experience

Prefer BSN or Masters in Behavioral Health

Additional background

  • Levels of care in the Behavioral Health

benefit structure – full continuum of care including IP, IOP, PHP, through

all routine outpatient services that compromise the full continuum of care

  • Relationship between Behavioral Health needs and PH needs and all Social Determinents of Health

  • Trauma informed

  • Non-traditional

providers as part of member s care team – peers, CHW, etc.

  • Belief and demonstration

of integration, person centered approach, operating in an

interdisciplinary team

  • Ability to influence



Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Master Social Worker (LMSW), Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse

Required Skills:

General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, General Business - Turning Data into Information, Leadership - Collaborating for Results

Desired Skills:

Benefits Management - Understanding Clinical Impacts, Leadership - Driving Change, Technology - Leveraging Technology

Additional Job Information:

Team leadership and team building skills.

Analytical and planning skills.

Negotiation/influencing skills.

Relationship and change management skills.

Organizational skills.

Time management skills.

Critical thinking skills.

Oral and written communication skills.

Benefit Eligibility

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

Job Function: Management

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.