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Job Field: Hospitality Jobs
Location: SANDY, UT
Job Type: Full Time

JOB SUMMARY:

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Licensed Behavioral Health Utilization Management Clinician Job Group Health Care Req# 9720BR Locations UT-Sandy Percent of Travel Required 0 - 10% Potential Telework Position Yes Full or Part Time Full Time Supervisory No Pay Opportunity Min $50,400 Pay Opportunity Max $66,200 Bonus Potential Variable % Job Description This is an in office position in either Aetnaapos;apos;s Sandy, UT or Blue Bell, PA facility. Candidate must be licensed in their home state in any behavioral or mental health licensure. Will work an 8 hour shift until 8:00 PM EST Monday to Friday. POSITION SUMMARY 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. This position will be part of the Behavioral Health Precert team who reviews outpatient care requests. This position will be office based initially with the possibility of telework at some point in the future. Below are the responsibilities for this position: - 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 - 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 Experience Required: - 3-5 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 - Managed care/precertification experience preferred - Crisis intervention skills preferred - Position requires proficiency in computers, which includes navigating multiple systems and keyboarding - Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing into the computer EDUCATION The highest level of education desired for candidates in this position is a Masterapos;apos;s degree in Behavioral/Mental health or Human Service/Health Services. LICENSES AND CERTIFICATIONS Mental Health/Licensed Clinical Social Worker (LCSW) is required Mental Health/Licensed Professional Counselor (LPC) is required Mental Health/Marriage amp; Family Therapist (LMFT) is required Nurses/Registered Nurse (RN) is required FUNCTIONAL EXPERIENCES Nursing/Mental Health/1-3 Years Clinical/Medical/Precertification/1-3 Years Clinical/Medical/Chemical dependency/1-3 Years TECHNOLOGY EXPERIENCES Aetna Applications/Aetna Behavioral Health/1-3 Years Aetna Applications/eTUMS -Total Utilization Management System Internet/1-3 Years Aetna Applications/Strategic Contracts Manager/1-3 Years Aetna Applications/Aetna Total clinical View/1-3 Years REQUIRED SKILLS Benefits Management/Interacting with Medical Professionals Benefits Management/Understanding Clinical Impacts General Business/Communicating for Impact DESIRED SKILLS General Business/Consulting for Solutions Leadership/Collaborating for Results Benefits Management/Maximizing Healthcare Quality Ple

KEY REQUIREMENTS:

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