Job Description

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. Required Qualifications: Kentucky Licensed Independent Behavioral Health Clinician (LPCC, LCSW, LMFT, LPAT) - OR - Active unrestricted Compact Registered Nurse (RN) license with psychiatric specialty or behavioral health experience. 3+ years clinical practice experience in a behavioral health setting e.g., psychiatric hospital, residential, or behavioral health treatment setting. 1+ year Electronic Medical Record documentation experience. Dedicated High Speed Internet Access. Preferred Qualifications: Residency in Kentucky or bordering counties. Experience working with Substance Use Disorder diagnoses. Managed care/utilization review experience. Medicaid experience. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Experience with MS office applications including Teams, Outlook, Word, and Excel. Remote work experience. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Education: Masters degree with a Behavioral Health Clinical License (LPCC, LCSW, LMFT, LPAT) OR Minimum of a Diploma RN or Associate's degree in Nursing.

By applying, you consent to your information being transmitted by Jooble to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See CVS Health Privacy Policy at and SonicJobs Privacy Policy at and Terms of Use at

Job Tags

Similar Jobs