Utilization Management Clinician Behavioral Health
$60,522–$129,615 year
RemoteUnited States
Job Summary
Conduct comprehensive assessments and evaluations of members' behavioral health needs to determine appropriate levels of care and treatment options. Collaborate with providers, members, and multidisciplinary teams to develop individualized care plans that promote positive clinical outcomes. Review clinical documentation, treatment plans, and progress notes to ensure compliance with medical necessity criteria and quality standards. Provide coaching and guidance to the UM team while participating in quality improvement initiatives to refine policies and procedures. Stay updated on industry guidelines and emerging trends to inform decision-making and enhance clinical practice. This role supports behavioral health outcomes for college and university students within the Aetna Student Health team.
Required Qualifications
- Active, unrestricted, independent clinical licensure in good standing, such as: LCSW (Licensed Clinical Social Worker), LMFT (Licensed Marriage and Family Therapist), LMSW (Licensed Masters Social Worker), LPC (Licensed Professional Counselor), RN (Registered Nurse)
- 3–5 years of behavioral health clinical experience
- Strong clinical assessment, problem-solving, and decision-making skills
- Knowledge of medical terminology and utilization management principles
- Ability to manage sensitive information with professionalism and discretion
- Strong communication and collaboration skills
- Must be willing to work in MST or PST
Desired Qualifications
- 3–5 years of Managed Care or Utilization Management experience
- Experience reviewing behavioral health services and treatment plans
- Familiarity with care coordination and interdisciplinary collaboration
- Knowledge of digital literacy skills
- Bachelor's or Master's degree in a relevant field, or equivalent professional training and qualifications
- Bachelors in Nursing, Master's in Social Work/Counseling/Psychology
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