Utilization Management Clinical Consultant - Behavioral Health

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MUST HAVE LICENSURE IN KENTUCKY - SEE REQUIRED QUALIFICATIONS FOR LICENSING DETAILS This is a fulltime remote Utilization Management Clinical Consultant opportunity with Aetna Better Health of Kentucky. This position will be utilized to provide multi-state coverage that will vary from day to day. The schedule is Monday-Friday, 8am-5pm with flexibility to work outside of the standard schedule based on business needs.

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. 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 facilitates including effective discharge planning. 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.