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Aetna Inc.

UM Clinician - BH

Aetna Inc. - San Bernardino, CA

UM Clinician - BH

in

San Bernardino

California

Req ID: 47290BR

POSITION SUMMARY

This position is for a Utilization Management Clinician residing in and licensed in the state of California.

That individual will perform utilization management, precert as well as concurrent review within the Autism Care team for members receiving Applied Behavior Analysis treatment/services.

Fundamental Components:

Applies critical thinking and is knowledgeable of evidence-based treatment and clinical practice guidelines for Behavioral Health, specific to ABA. The majority of time is spent at a desk and on the telephone reviewing precertification/concurrent cases with the treating provider using specific criteria and making decisions to authorize additional services for our members or refer to a physician for a determination. Collaborates with providers/facilities to ensure appropriate planning to meet member needs

BACKGROUND/EXPERIENCE desired:

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 is required

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Work requires sitting for extended periods, talking on the telephone and typing into the computer

Sedentary work involving periods of sitting, talking, listening.

Managed care/utilization review experience preferred

Crisis intervention skills preferred

EDUCATION

The minimum level of education desired for candidates in this position is a Master's degree.

LICENSES AND CERTIFICATIONS

Mental Health/Licensed Clinical Social Worker (LCSW) is required

OR

Mental Health/Licensed Professional Counselor (LPC) is required

OR

Mental Health/Licensed Psychologist is required

OR

Nursing/Registered Nurse (RN) is required

OR

Mental Health/Marriage & Family Therapist (MFT) is required

FUNCTIONAL EXPERIENCES

Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1 Years

Functional - Clinical / Medical/Concurrent review / discharge planning/1 Years

Functional Experience/Functional Focus/ 1 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/Microsoft Outlook/1 Years/End User

Technical - Desktop Tools/Microsoft Word/1 Years/End User

REQUIRED SKILLS

Benefits Management/Interacting with Medical Professionals/ADVANCED

Benefits Management/Understanding Clinical Impacts/FOUNDATION

General Business/Consulting for Solutions/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/FOUNDATION

General Business/Communicating for Impact/FOUNDATION

Leadership/Driving a Culture of Compliance/FOUNDATION

ADDITIONAL JOB INFORMATION

This is an opportunity to be part of a high performing dynamic team while enjoying the flexibility of working from home.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

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.

Job Function: Health Care

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5 days 4 hours ago

Aetna Inc.

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UM Clinician - BH Aetna Inc. - San Bernardino, CA, United States

   

Location: San Bernardino, CA

Company Profile:
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees’ dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The company’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.