Aetna UM Clinician - BH in Richfield, Ohio

Req ID: 55363BR

Please note: this position is full time work at home

POSITION SUMMARY

This position is for a Utilization Management Clinician -BH, on the Autism Care Team. That individual will perform utilization management, precert as well as concurrent review within the Autism Care team for members receiving Applied Behavior Analysis (ABA) treatment/services for Autism. A license to practice in the state in which you live is required.

Fundamental Components:

Applies critical thinking and is knowledgeable of evidence-based treatment and clinical practice guidelines for Behavioral Health, specific to ABA. The majority of time is spent at a desk and on the telephone reviewing precertification/concurrent cases with the treating provider using specific criteria and making decisions to authorize additional services for our members or refer to a physician for a determination. Collaborates with providers/facilities to ensure appropriate planning to meet member needs.

BACKGROUND/EXPERIENCE:

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

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

Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer

Autism/ABA experience preferred

Managed care/utilization review experience preferred

Crisis intervention skills preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Master's degree OR Bachelor's degree for RN candidates

LICENSES AND CERTIFICATIONS

Mental Health/Licensed Clinical Social Worker is required

OR

Mental Health/Licensed Professional Counselor is required

OR

Mental Health/Marriage & Family Therapist is required

OR

Nursing/Registered Nurse is required

FUNCTIONAL EXPERIENCES

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

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

FunctionalExperience/FunctionalFocus/1+ Years

Functional - Clinical / Medical/Precertification/1+ Years

TECHNOLOGY EXPERIENCES

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

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

Technical - Operating Systems/Windows/1+ Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Consulting for Solutions/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

Telework Specifications:

Full-Time Telework (WAH)

ADDITIONAL JOB INFORMATION

This is an opportunity to be part of a high performing dynamic team while enjoying the flexibility of working from home.

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.