Aetna Care Manager BH in Princeton, New Jersey
Req ID: 50196BR
Provides case management services which may include pre-admission, concurrent, discharge and/or retro review, follow-up assessment or outreach phone.
Fundamental Components: Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes. Provide telephone triage, crisis intervention and emergency authorizations as assigned. Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria. Interact with Physician Advisors to discuss clinical/authorization questions and concerns regarding specific cases. Participate in QI activities including data collection, tracking, and analysis. A Behavioral Health Care Manager who is a licensed Psychologist may render denials when the coverage request is within the psychologist's scope of practice and his or her clinical experience. Inpatient care and prescription medication denials can only be rendered by a psychiatrist unless state regulations permit these denials to be rendered by a psychologist
BACKGROUND/EXPERIENCE desired: 3 years post degree experience in a psychiatric or substance abuse setting requiredLCSW or RN with Clinical Background is required3-5 years experience in managed care. Experienceworking with members with developmental disabilities
The highest level of education required for candidates in this position is a Bachelor's degree or equivalent experience.
ADDITIONAL JOB INFORMATION
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.
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Job Function: Health Care