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Behavioral Health Utilization Management Clinician

Primary Location: Blue Bell, Pennsylvania
Additional Locations: PA-Allentown, PA-Bethlehem, PA-Blue Bell
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Description:

Work at Home - Hours will be 10:30am-7:00pm

The Aetna Medicare BH UMC works within an integrated team to perform utilization review, as well as proactive discharge planning. This includes working in close collaboration with our business partners, as well as the enterprise to promote overall wellness for our members. 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. The majority of time is spent at a desk and
on telephonic or records review of precertification/concurrent/retrospective
cases with the treating provider/records using specific criteria and making
decisions to authorize services for our members OR refer to a physician for a
determination. These clinicians also collaborate with providers/facilities to
ensure appropriate planning to meet member needs.


Background Experience:

Minimum 3+ years of direct clinical practice experience post-masters degree or RN/BSN, e.g., hospital
setting or alternative care setting such as ambulatory care or outpatient clinic/facility.

Managed care/utilization review experience preferred,

Crisis intervention skills preferred.

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 into the computer.



Additional Job Information:
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 expert dealing with Medicare and in providing support and
education to the staff.


Required Skills:
Service - Working Across Boundaries, Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Understanding Clinical Impacts

Education:
Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Mental Health Counseler, Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse (RN)

Potential Telework Position:
Yes

Percent of Travel Required:
0 - 10%

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

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this 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

Click To Review Our Benefits (PDF)

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