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.

POSITION SUMMARY

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:

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.

BACKGROUND/EXPERIENCE desired:

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

EDUCATION

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

OR

Mental Health/Licensed Professional Counselor (LPC) is required

OR

Mental Health/Licensed Mental Health Counselor (LMHC) is required

OR

Mental health/Licensed Social Worker (LSW) is required

OR

Licensed Marriage and Family Therapist (LMFT) is required

OR

Nursing/Registered Nurse (RN) is required

FUNCTIONAL EXPERIENCES

Functional - Nursing/Mental Health/1+ Years

Functional - Clinical / Medical/Precertification/1+ Years

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1+ Years

TECHNOLOGY EXPERIENCES

Technical - Aetna Applications/Aetna Behavioral Health/1+ Years/End User

Technical - Aetna Applications/Aetna Total clinical View/1+ Years/End User

Technical - Aetna Applications/Aetna Strategic Desktop Reporting/1+ Years/End User

Technical - Aetna Applications/Strategic Contracts Manager/1+ Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Communicating for Impact/FOUNDATION

Technology/Leveraging Technology/FOUNDATION

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

Leadership/Collaborating for Results/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

  • 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.

    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