Aetna Utilization Management Clinician – Behavioral Health in Phoenix, Arizona
Req ID: 64568BR
This role is office based in Phoenix, AZ
Standard business hours are required Monday-Friday
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 included but are not limited to:
-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 facilitates including effective discharge planning.
-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.
Qualifications Requirements and Preferences:
-3+ years of direct clinical practice experience post masters degree required
-Unencumbered Behavioral Health clinical license for Arizona is required (i.e. LPC, LCSW, LISAC, LMFT)
-Crisis intervention skills preferred
-Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
-Managed care/utilization review experience preferred
-Minimum of a Master's degree in Behavioral/Mental health or Human Service/Health Services required
-Sedentary work involving periods of sitting, talking, listening.
-Work requires sitting for extended periods, talking on the telephone and typing into the computer
Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Professional Counselor
Clinical / Medical - Concurrent review / discharge planning
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word
Benefits Management - Shaping the Healthcare System, Benefits Management - Understanding Clinical Impacts
General Business - Communicating for Impact, General Business - Consulting for Solutions
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Healthcare
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.