Aetna Better Health is hiring for multiple openings across the state/regions of Kentucky. For a full list of our available clinical roles, please click HERE.
Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.
This position requires the ability to travel up to 50% of the time with use of a personal vehicle. Must have active KY driver's license, proof of vehicle insurance, and reliable transportation. Routine and frequent visitation to assigned hospitals in the region is required. Travel to the Louisville office is also anticipated for meetings and training.
This position is assigned to the Northern Bluegrass region (Boone, Bourbon, Campbell, Carroll, Gallatin, Grant, Harrison, Kenton, Nicholas, Owen, Pendleton, and Scott counties). Qualified candidates may reside in or adjacent to the assigned region.
Aetna is an Equal Opportunity, Affirmative Action Employer
Assessment of Members:
Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
Enhancement of Medical Appropriateness and Quality of Care:
Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
Identifies and escalates quality of care issues through established channels.
Ability to speak to medical and behavioral health professionals to influence appropriate member care.
Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.
Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
Monitoring, Evaluation and Documentation of Care:
In collaboration with the member and their care team, develops and monitors established plans of care to meet the member's goals.
Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Minimum of a Master's degree in Behavioral/Mental Health or related field.
Unencumbered Behavioral Health clinical license in the state of KY (eg., LCSW, LPCC, LMFT) required.
3-5 years of direct clinical practice experience required post Master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
Managed care/utilization review experience preferred.
Case management and discharge planning experience preferred.
Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.
Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required. We are serving the needs of children and families that may require working after school, after work, etc.
Benefit eligibility may vary by position.
Candidate Privacy Information
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