Aetna UM Clinician - Behavioral Health in Sandy, Utah
Req ID: 51934BR
Please note: Hours for this position are 8AM-4:30PM M-F in candidates respective time zone.
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.
Ability to assess needs for treatment of chemical dependency and mental health issues, including appropriate level of care required.
Ability to document clinical information concisely and clearly.
Ability to synthesized clinical data and make appropriate recommendations to Medical Directors.
Ability to interact professionally with a wide range of providers and utilization management staff.
Sedentary work involving periods of sitting, talking, listening.
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
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Work requires sitting for extended periods, talking on the telephone and typing into the computer
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.
LICENSES AND CERTIFICATIONS
Mental Health/Licensed Clinical Social Worker (LCSW) is required
Mental Health/Licensed Professional Counselor (LPC) is required
Mental Health/Licensed Mental Health Counselor (LMHC) is required
Mental health/Licensed Social Worker (LSW) is required
Licensed Marriage and Family Therapist (LMFT) is required
Nursing/Registered Nurse (RN) is required
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Technical - Aetna Applications/Aetna Behavioral Health/1+ Years/End User
Technical - Aetna Applications/Aetna Total clinical View/1+ Years/End User
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Technical - Aetna Applications/Strategic Contracts Manager/1+ Years/End User
Benefits Management/Interacting with Medical Professionals/ADVANCED
General Business/Communicating for Impact/FOUNDATION
Benefits Management/Maximizing Healthcare Quality/FOUNDATION
Leadership/Collaborating for Results/FOUNDATION
Leadership/Driving a Culture of Compliance/FOUNDATION
Full-Time Telework (WAH) for current WAH employees.
New employees: Telework will be considered. Employees must live within an hour of an Aetna office.
ADDITIONAL JOB INFORMATION
This position will be part of the Behavioral Health Precert team who reviews outpatient care requests. Below are the responsibilities for this position: - 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 - 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 Experience Required: 3-5 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 Managed care/precertification experience preferred Crisis intervention skills preferred 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. Education and Certification Requirements: Licensed
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.
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Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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Job Function: Health Care