Aetna Applied Behavior Analysis UM Clinical Consultant in Baton Rouge, Louisiana
Req ID: 52367BR
Please note: Telework is considered for candidates outside of the Baton Rouge/New Orleans area
The UM Clinical Consultant - ABA applies critical thinking and knowledge in clinically appropriate treatment, evidence based care and medical necessity criteria for appropriate utilization of services.
The UMCC utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
Position requires proficiency with computer skills 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 on the computer.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Typical office working environment with productivity and quality expectations.
Position may require working on-site Self-motivated and confident making clinical decisions, ability to influence and shape clinical outcomes
Fundamental Components include:
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 medical necessity criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care
Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members including urgent or emergent interventions (such as triage / crisis support)
Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment
Identifies members who may benefit from care management programs and facilitates referral -Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
ABA certification required.
3+ years clinical practice experience in ABA services required.
Possesses sound clinical judgment is required
Strong organizational skills are required
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment is required
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Strong documentation skills and broad based clinical knowledge is required
Managed care/utilization review experience preferred
Experience and knowledge in clinical guidelines, systems and tools i.e., MCG/Milliman, LOCUS, CALOCUS/CASII is preferred
Knowledge of provider networks and delivery, ability to interface with providers with an attention to detail is preferred
The minimum level of education desired for candidates in this position is a Master's degree.
LICENSES AND CERTIFICATIONS
Licensed independent Behavioral Health clinician in state of service with unrestricted state license is required.
Telework considered for candidates outside of the Baton Rouge/New Orleans area
ADDITIONAL JOB INFORMATION
Are you ready to join a company that is changing the face of health care across the nation? Aetna Better Health of Louisiana is looking for people like you who value excellence, integrity, caring and innovation. As an employee, youll join a caring team dedicated to improving the lives of the most vulnerable in our population. Our vision incorporates community-based health care that works. We value diversity. Align your career goals with Aetna Better Health of Louisiana, and we will support you all the way.
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.
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Job Function: Health Care