Aetna Business Consultant - Utilization Management- Behavioral Health (60078BR) in Phoenix, Arizona
Req ID: 60078BR
Medicaid UM Shared Services staff are involved in managing standard operating practices, partner with local plan markets on new and existing initiatives.
Fundamental Components included but are not limited to:
Supports holistic solutions and/or key strategic plans. Proactively identifies opportunities for improvement within assigned initiatives
Conducts thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., outsourcing, process improvements, technology solutions)
Participates in influencing client contracting process, builds optimal client relationship for results and deliverables and manages relationship throughout engagement
Participates and supports metrics integration and execution for optimal results. Shares joint accountability for initiative s return on investment
Communicates compelling and concise results to empower client groups in decision making process regarding project opportunities
Participates in initiative planning as required. Supports engagement using a disciplined repeatable methodology
Designs, develops interventions and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials
Gathers, analyzes and synthesizes business intelligence to drive achievement of strategic business objectives
Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer
Qualifications Requirements and Preferences:
Behavioral Health Inpatient treatment setting in last 5 years
Behavioral Health UM experience including Program Development within UM
Health Plan Leadership
Process Driven with prior authorization and concurrent review experience
Prefer BSN or Masters in Behavioral Health
- Levels of care in the Behavioral Health
benefit structure – full continuum of care including IP, IOP, PHP, through
all routine outpatient services that compromise the full continuum of care
Relationship between Behavioral Health needs and PH needs and all Social Determinents of Health
providers as part of member s care team – peers, CHW, etc.
- Belief and demonstration
of integration, person centered approach, operating in an
- Ability to influence
Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Master Social Worker (LMSW), Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse
General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, General Business - Turning Data into Information, Leadership - Collaborating for Results
Benefits Management - Understanding Clinical Impacts, Leadership - Driving Change, Technology - Leveraging Technology
Additional Job Information:
Team leadership and team building skills.
Analytical and planning skills.
Relationship and change management skills.
Time management skills.
Critical thinking skills.
Oral and written communication skills.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Job Function: Management
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.