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Aetna is now a CVS Health Company

Utilization Management/Concurrent Review Clinician- Behavioral Health

Primary Location: Sandy, UT
Additional Locations: CA-Aliso Viejo, CA-Chatsworth, CA-Concord, CA-Culver City, CA-Cupertino, CA-Fremont, CA-Gold River, CA-Los Angeles, CA-San Diego, CA-San Francisco, CA-Santa Ana, CA-Stockton, CA-Thousand Oaks, CA-W. Sacramento, CA-Woodland Hills, UT-Sandy
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.

Standard business hours Monday-Friday only and available to work pacific coast hours.

This is a telework, remote and work at home role.

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
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 must be independently licensed

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.

Required Skills:
Benefits Management - Encouraging Wellness and Prevention, Benefits Management - Interacting with Medical Professionals, Benefits Management - Maximizing Healthcare Quality

Desired Skills:
Benefits Management - Shaping the Healthcare System, Benefits Management - Understanding Clinical Impacts, Service - Creating a Differentiated Service Experience

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

Technology Experience:
Desktop Tool - Microsoft Outlook

Mental Health - Licensed Clinical Social Worker, Mental Health - Licensed Independent Social Worker, Mental Health - Licensed Master Social Worker (LMSW), Mental Health - Licensed Mental Health Counseler, Mental Health - Licensed Professional Counselor, Mental Health - Licensed Psychologist, Mental Health - Licensed Social Worker (LSW)

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 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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