Business Consultant - Utilization Management- Behavioral Health (60078BR)Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix Apply
Medicaid UM Shared Services staff are involved in managing standard operating practices, partner with local plan markets on new and existing initiatives.
60078Fundamental 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
- 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
providers as part of member’s care team – peers, CHW, etc.
- Belief and demonstration
of integration, person centered approach, operating in an
- Ability to influence
Additional Job Information: Team leadership and team building skills.
Analytical and planning skills.
Relationship and change management 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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