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Business Consultant - Utilization Management- Behavioral Health (60078BR)

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
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Description:

Medicaid UM Shared Services staff are involved in managing standard operating practices, partner with local plan markets on new and existing initiatives.



Fundamental Components:
Supports holistic solutions and/or key strategic plans. Proactively identifies opportunities for improvement within assigned initiatives
Conducts thorough business case and external customer value analysis to determine selection, prioritization positioning and approach for broadest range of potential solutions (e.g., outsourcing, process improvements, technology solutions)
Participates in influencing client contracting process, builds optimal client relationship for results and deliverables and manages relationship throughout engagement
Participates and supports metrics integration and execution for optimal results. Shares joint accountability for initiative’s return on investment
Communicates compelling and concise results to empower client groups in decision making process regarding project opportunities
Participates in initiative planning as required. Supports engagement using a disciplined repeatable methodology
Designs, develops interventions and facilitates work sessions. Develops and delivers all required analysis, reporting and presentation materials
Gathers, analyzes and synthesizes business intelligence to drive achievement of strategic business objectives
Builds and utilizes diverse internal and external networks, as appropriate, for data gathering and best practice identification. Leverages internal and external networking to drive optimal initiative results and knowledge/best practice transfer

Background Experience:

Behavioral Health Inpatient treatment setting in last 5 years

Behavioral Health UM experience including Program Development within UM

Health Plan Leadership

Process Driven with prior authorization and concurrent review experience

Prefer BSN or Masters in Behavioral Health

Additional background

  • Levels of care in the Behavioral Health
    benefit structure – full continuum of care including IP, IOP, PHP, through
    all routine outpatient services that compromise the full continuum of care

  • Relationship between Behavioral Health needs and PH needs and all Social Determinents of Health

  • Trauma informed

  • Non-traditional
    providers as part of member’s care team – peers, CHW, etc.

  • Belief and demonstration
    of integration, person centered approach, operating in an
    interdisciplinary team

  • Ability to influence
    colleagues





Additional Job Information:
Team leadership and team building skills.
Analytical and planning skills.
Negotiation/influencing skills.
Relationship and change management skills.
Organizational skills.
Time management skills.
Critical thinking skills.
Oral and written communication skills.


Required Skills:
General Business - Demonstrating Business and Industry Acumen, General Business - Maximizing Work Practices, General Business - Turning Data into Information, Leadership - Collaborating for Results

Desired Skills:
Benefits Management - Understanding Clinical Impacts, Leadership - Driving Change, Technology - Leveraging Technology

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

Potential Telework Position:
Yes

Percent of Travel Required:
10 - 25%

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 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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Click To Review Our Benefits (PDF)

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