Aetna UM Clinician - Behavioral Health in Richfield, Ohio

Req ID: 56769BR

This is a full-time telework role anywhere in the US.

This is an exciting job opportunity to work with a group of skilled clinicians completing precertification from providers for members in need of mental health and chemical dependency treatment. Challenge yourself as you work identifying barriers and promoting positive member outcomes while maintaining autonomy. The Medical Director is an expert dealing with Medicare and in providing support and education to the staff.


Medicare behavioral health precertification for ambulatory and inpatient level of care. Identifying and applying the correct criteria and medical necessity to meet individual needs which includes assessment, treatment planning, dc planning to enhance member outcomes

Fundamental Components:

Utilize critical thinking skills in Medicare behavioral health utilization management for ambulatory and inpatient levels of care. Identifying and applying the correct criteria and medical necessity to meet individual needs which includes assessment, treatment planning, dc planning and level of care appropriate to enhance member outcomes

Required Skills & Experience:

  • Active and unrestricted licensure in the state where applicant resides, RN - BSN, LCSW, LPC or equivalent

  • 1+ years of direct clinical practice experience post licensure

  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

  • Work requires sitting for extended periods, talking on the telephone and typing on the computer

Preferred Skills & Experience:

  • Acute care setting experience

  • Managed care/utilization review experience

  • Crisis intervention skills


The minimum level of education required for candidates in this position is a Bachelor's degree or equivalent experience.


At least one of the following is required:

Mental Health/Licensed Clinical Social Worker

Nursing/Registered Nurse (RN)

Mental Health/Licensed Social Worker (LSW)

Mental Health/Licensed Professional Counselor


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

Functional - Clinical / Medical/Precertification/1+ Years

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

Functional - Nursing/Concurrent Review/discharge planning/1+ Years

Functional - Nursing/Mental Health/1+ Years


Benefits Management/Interacting with Medical Professionals/ADVANCED

General Business/Communicating for Impact/FOUNDATION

Technology/Leveraging Technology/FOUNDATION


Benefits Management/Encouraging Wellness and Prevention/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 candidates'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

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.