Aetna Clinical Case Manager BH in New Albany, Ohio

Req ID: 47558BR


This position will support the A1A Behavioral Health team. The team will be located in the New Albany office. 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 outcomes.

Fundamental Components:

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.

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.

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. - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.


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

Must be a STRONG typist & highly organized with ability to quickly prioritize

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 Clinical Social Worker is required


Mental Health/Licensed Independent Social Worker is required


Mental Health/Licensed Professional Counselor is required


Mental Health/Licensed Psychologist is required


Functional - Clinical / Medical/Disease management/1+ Years

Functional - Clinical / Medical/Concurrent review / discharge planning/1+ Years

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

Functional - Medical Management/Medical Management - Clinical coverage and policies/1+ Years

Functional - Medical Management/Medical Management - Direct patient care/1+ Years


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

Technical - Desktop Tools/Microsoft Word/1+ Years/End User

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


Benefits Management/Encouraging Wellness and Prevention/ADVANCED

Benefits Management/Understanding Clinical Impacts/ADVANCED

General Business/Applying Reasoned Judgment/ADVANCED


General Business/Communicating for Impact/FOUNDATION

Leadership/Collaborating for Results/MASTERY

Technology/Leveraging Technology/FOUNDATION

Telework Specifications:

This position is for a full time office based employee.

The candidate must live within driving distance to the New Albany office.


Candidate must be licensed in the state in which they will be working

Requires knowledge of mental health and substance abuse disorders

Must be able to talk on the telephone and type at the same time

Experience using Motivational Interviewing and good technological skills are a plus

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