Phoenix, Arizona

Job Description
The BH UM Clinical Consultant position is a full time office based position. Offices are temporarily closed due to COVID 19; consequently, this position will telework temporarily until the office reopens.

This position requires the ability to travel in state with a personal vehicle up to 10% of the time. Qualified candidates must have a valid AZ driver's license, reliable transportation, and proof of vehicle insurance.

Position will be considered for telework after being in the office for 6 months to a year, or as determined by management.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services.

At Mercy Care, our vision is for our members to live their healthiest lives and achieve their full potential. We’re a local company, serving Arizonans of all ages who are eligible for Medicaid since 1985. We also serve people who are eligible for both Medicaid and Medicare. Mercy Care is sponsored by Dignity Health and Ascension Health and is administered by Aetna, a CVS Health Business. In April 2021 we’re going to begin delivering integrated physical and behavioral health services to children involved with the child welfare system, in a unique partnership with the Arizona Department of Child Safety and their Comprehensive Health Plan. We value diversity, compassion, innovation, collaboration and advocacy. If your values are the same as ours, let’s work together to make a difference and improve the health and wellbeing of Arizona.

- 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.
- Typical office working environment with productivity and quality expectations.
- Work requires the ability to perform close inspection of hand-written and computer-generated documents as well as a PC monitor.
- Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

Required Qualifications
- Licensed independent Behavioral Health clinician in state of service or a Registered Nurse (RN) with unrestricted state license.
- 3+ years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
- 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.

Preferred Qualifications
- Managed care/utilization review experience preferred.
- 5+ years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care preferred.

Education
- Associate's Degree required with RN licensure.
- Master's degree required with Licensed independent Behavioral Health clinician.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.


We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. See Job Description

Phoenix, Arizona

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