Aetna Utilization Management Clinician – Behavioral Health in Phoenix, Arizona
Req ID: 67489BR
This role is office based in Phoenix, AZ with potential for work at home after successful office based period.
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 included but are not limited to:
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 facilitates including effective discharge planning.
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.
Qualifications Requirements and Preferences:
Unencumbered Behavioral Health clinical license for Arizona required (LPC, LCSW, or LMFT)
3+ years of direct clinical practice experience post masters degree required
Master's degree in Behavioral/Mental health or Human Service/Health Services required
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Managed care/utilization review experience preferred
- Sedentary work involving periods of sitting, talking, listening
- Work requires sitting for extended periods, talking on the telephone and typing into the computer
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact
Additional Job Information:
Benefit eligibility may vary by position.
Job Function: Healthcare
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.