Monday , May 20 2024

Aetna Insurance Jobs – UM Clinical Consultant

Website Aetna

Job Description:

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

Job Responsibilities:

  • Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
  • 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.
  • Provides triage and crisis support.
  • Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
  • 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.
  • Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
  • Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
  • Coordinates with providers and other parties to facilitate optimal care/treatment.

Job Requirements:

  • Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
  • Licensed independent Behavioral Health clinician for Virginia or a Registered Nurse (RN) with unrestricted Virginia state license with psychiatric specialty, certification, or experience
  • 3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Richmond, VA, US

Application Deadline: N/A

Apply Here

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