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Utilization Management Clinician – Behavioral Health

Primary Location: Phoenix, AZ
Additional Locations: AZ-Phoenix
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Description:
This role is office based in Phoenix, AZ
Standard business hours are required Monday-Friday


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.

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 required
-Unencumbered Behavioral Health clinical license for Arizona is required (i.e. LPC, LCSW, LISAC)
-Crisis intervention skills preferred
-Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
-Managed care/utilization review experience preferred
-Minimum of a Master's degree in Behavioral/Mental health or Human Service/Health Services required
-Sedentary work involving periods of sitting, talking, listening.
-Work requires sitting for extended periods, talking on the telephone and typing into the computer

Required Skills:
Benefits Management - Interacting with Medical Professionals, Benefits Management - Understanding Clinical Impacts

Functional Skills:
Clinical / Medical - Concurrent review / discharge planning

Technology Experience:
Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel

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

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. 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.

Click To Review Our Benefits (PDF)

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