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UM Clinician, Behavioral Health

Primary Location: Blue Bell, PA
Additional Locations: PA-Blue Bell
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.

Scheduled is standard business hours, no nights, no weekends and no holidays.

Remote position.

Fundamental Components:
Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, apply evidence based standards and practice guidelines to treatment where appropriate. Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Provides triage and crisis support. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning. Coordinates with providers and other parties to facilitate optimal care/treatment. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

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 (drug & alcohol mental health experience)
Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone and typing into the computer
Crisis intervention skills preferred
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Managed care/utilization review experience preferred Unencumbered Behavioral Health

Clinical license in the state where they work active and unrestricted
RN, MSW, LSW, LISW, LPC, etc are preferred

BSN preferred
Minimum of a Master's degree in Behavioral/Mental health or Human Service/Health Services (as applicable to hiring program) or Registered Nurse with Behavioral Health experience/background.

Additional Job Information:
Be part of a highly professional team in this challenging role for Medicare members. You will use your critical decision making skills and are encouraged to be autonomous as you interact with facilities, our physicians and members of our team in decision making. We manage a large portion of our geriatric population with comorbid issues and our younger members who are our chronic challenging population as we strive to drive wellness and positive outcomes.

Required Skills:
Benefits Management - Understanding Clinical Impacts, General Business - Applying Reasoned Judgment, General Business - Maximizing Work Practices

Desired Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals

Functional Skills:
Nursing - Mental Health

Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Independent Social Worker, Mental Health - Licensed Master Social Worker (LMSW), Mental Health - Licensed Professional Counselor, Nursing - Registered Nurse

Potential Telework Position:

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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