Aetna Behavioral Health Specialist (LPC or LISW) in New Albany, Ohio

Req ID: 51157BR

This role is office based in New Albany, OH


Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and

behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination

of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective


Fundamental components include but are not limited to:

Assessment of Members:

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred

members needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating members

benefit plan and available internal and external programs/services.- Applies clinical judgment to the incorporation of

strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and

resolution of member issues.

  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical

    crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically

    indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.

    Enhancement of Medical Appropriateness and Quality of Care:- Application and/or interpretation of applicable criteria

    and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while

    assessing benefits and/or members needs to ensure appropriate administration of benefits

  • Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to

    meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve

    optimal outcomes

  • Identifies and escalates quality of care issues through established channels

    -Ability to speak to medical and behavioral health professionals to influence appropriate member care.

  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/

    behavior changes to achieve optimum level of health

    -Provides coaching, information and support to empower the member to make ongoing independent medical and/or

    healthy lifestyle choices.

    -Helps member actively and knowledgeably participate with their provider in healthcare decision-making

    -Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify

    comprehensive member needs.

    Monitoring, Evaluation and Documentation of Care:-In collaboration with the member and their care team develops

    and monitors established plans of care to meet the members goals


    One of the following licenses is required: LPC or LISW

    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 is required

    Case management and discharge planning experience preferred

    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.


    Mental Health/Licensed Independent Social Worker is desired

    Mental Health/Licensed Professional Counselor is desired


    Functional - Nursing/Mental Health/4-6 Years

    Functional - Medical Management//1-3 Years


    Technical - Aetna Applications/Aetna Total clinical View/1-3 Years/End User

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


    Benefits Management/Encouraging Wellness and Prevention/ADVANCED

    Benefits Management/Interacting with Medical Professionals/ADVANCED


    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