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Utilization Management Clinical Consultant

Primary Location: Baton Rouge, LA
Additional Locations: LA-Baton Rouge
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Description:
The Behavioral Health Utilization Management Clinical Consultant utilizes clinical skills to coordinate, document and communicate the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.


Onsite role.

No nights, no holidays and no weekends!

Schedule is 8am-5pm.


Fundamental Components:
Fundamental components include:
• Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
• Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions
• Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
• Identifies members who may benefit from care management programs and facilitates referral
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization


Candidates should have:
• Experience and knowledge in clinical guidelines, systems and tools such as MCG, LOCUS, CASII, and ASAM
• Knowledge of provider networks and delivery
• Strong organizational skills with an attention to detail
• Ability to work independently and on a team
• Strong documentation skills and broad based clinical knowledge
• Behavioral health and physical health integrated care experience
• Be self-motivated and confident making clinical decisions with the ability to influence and shape clinical outcomes •
• Proficiency with computer skills which includes navigating multiple systems
• Ability to multitask, prioritize and effectively adapt to a fast-paced, changing environment


Background Experience:
3 years of behavioral health clinical practice experience required.
Managed care/utilization review experience strongly preferred.
Experience working in the Louisiana Medicaid Behavioral Health system strongly preferred.

Must be a Licensed Mental Health Professional with one of the following unrestricted LA state licenses:
(a) Medical psychologist.
(b) Licensed psychologist.
(c) Licensed clinical social worker (LCSW).
(d) Licensed professional counselor (LPC).
(e) Licensed marriage and family therapist (LMFT).
(f) Licensed addiction counselor (LAC).
(g) Licensed Advanced Practice Registered Nurse (APRN).
(h) Licensed rehabilitation counselor (LRC).


Additional Job Information:
Typical office working environment with productivity and quality expectationsWork requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.Ability to multitask, prioritize and effectively adapt to a fast paced changing environmentPosition requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Potential Telework Position:
No

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate'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.

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