Insurance Jobs – UM Clinical Consultant
Found in: beBee jobs US - 7 days ago
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.
[ads1]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.
- 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
Company: Aetna
Vacancy Type: Full Time
Job Location: Richmond, VA, US
Application Deadline: N/A
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