Job Brief:
Earth Networks has an exciting opportunity to join our Virtual Behavioral Health integration team. This is a transformational approach to identifying patients early and providing them the access and support they need to address their behavioral health issues BEFORE they become unmanageable. This position will work with patients and primary care physicians COMPLETELY VIRTUALLY. We are looking for experienced licensed behavioral health clinicians who want to make an impact while working from the comfort of their own home environment. Come and join our team and have a fulfilling opportunity to make a difference for patients who need behavioral health care!

Responsibilities:

• Provides health coaching and education.
• Assesses health issues and creates care plans for members.
• Develops educational curriculum, materials and presentations.
• Review's documentation and evaluates potential quality of care issues based on clinical policies and benefit determinations.
• Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
• Data gathering requires navigation through multiple system applications.
• Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
• Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
• Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
• Commands a comprehensive knowledge of complex delegation arrangements, contracts (member and provider), clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
• Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
• Condenses complex information into a clear and precise clinical picture while working independently.
• Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.

Skills Required:

• 3+ years of clinical experience required.
• RN with current unrestricted state licensure required.
• 2+ years' experience working with data, data analysis and trending
• Demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Word, Excel, Outlook, SharePoint, etc.).
• Must reside in LA.
• Ability to travel 5-10% of the time for in-state meetings. Must have access to reliable transportation.

Preferred Qualifications:

• Managed Care experience preferred.
• BSN education/degree is preferred.