Aetna Prior Authorization Jobs (NOW HIRING)

JOB RESPONSIBILITIES

• Care Delivery- Developing and implementing an individual crisis and safety plan as needed in conjunction with the youth and family. Facilitate referrals and linkages, monitor care plan implementation. Manage 1915(c) Waiver funds ensuring prior authorization and ODM approval is obtained. Ensuring effective referrals and linkages with appropriate assessments, support, and services. Ensuring that all services, supports, and care management processes respect the youth and family's rights to define their specific goals and choose their providers and resources, and monitoring to ensure that all supports and services are family friendly and culturally competent. Facilitates member outreaches, assessments, and meetings in person and in the community or virtually dependent upon guardian/member preference. Operates at a ratio of Intensive Care Coordination (ICC)-1:10Moderate Care Coordination (MCC)- 1:20. Caseloads can be a mix of ICC and MCC, if warranted. In addition to BHCCS I responsibilities frequently integrates comprehensive and evidence-based strategies into CFT meetings. Demonstrates deeper knowledge of behavioral health management skills.
• Plan of care- Implement/document patient response to individualized care plans which may include completing behavioral assessments. Implement/document patient response to individualized care plans. Participate in regular team planning meetings as appropriate or needed. Engage newly referred youth and family in care coordination. Partner with family to develop Child and Family-Centered Care Plan (CFCCP) and to identify client family team. Facilitate Child and Family Team (CFT) meetings at least monthly or more frequently depending on need. Complete comprehensive assessments including Child and Adolescent Needs and Strength (CANS) assessments. Engaging the youth and their family in forming their unique CFT, preparing them to be full partners in the assessment, planning, and implementation of their care plan. Convening CFT meetings, ensuring that CFT meetings are convenient for the family. In addition to BHCCS I responsibilities, consistently implements trauma informed care principles and culturally responsive approach to care delivery. Care planning reflects consistent adherence to the wraparound model of care in addition to reflecting a higher level of innovation and resourcefulness.
• Therapeutic Relationships/Communication- In addition to BHCCS I responsibilities, coach and develop new staff, demonstrate enhanced quality in care planning and relationship management with both family, CFT members, and community partners. Engages with system of care peers to ensure adherence to the model. Serving as the facilitator of the CFT, ensuring that the CFCCP development is a collaborative effort of all the Team members. Serving as the point person for the CFT, remaining in contact with all members to ensure implementation and effectiveness of the CFCCP, monitoring the commitments of the team members and assisting with implementation issues. Coordinating care with all providers and agencies with whom the family is involved, including youth's physical health providers and school personnel. Communicating ongoing CFCCP implementation progress and updated strategies to all Team members, obtaining their cooperation and approval. Working with others to develop community resources to meet youth and families' needs as identified. Utilizing culturally competent and trauma informed care principals. In addition to BHCCS I responsibilities, demonstrates higher engagement with patients and family. Demonstrates ability to increase participants in CFTs and moderate level of CFT facilitation skills in adherence with the wraparound model of care.
• Documentation and Data Management- Completes patient care plan documentation accurately and in a timely fashion as established by the department or patient care needs. Bill for care coordination activities. Ensuring quality information management and documentation, including attendance of team members and their approval of the CFCCP are documented in the youth's EHR. Ensuring that the written CFCCP is signed by the youth (as age appropriate), family/caregiver(s), and the Care Coordinator and placed in the youth's record within 2 weeks of the CFT meeting. Ensuring that the CFCCP is provided to Aetna for quality review and initiating the authorization process for services as needed and within timeframe indicated by ODM. Develop SMART goals with clear identified measures for achieving/meeting goals. In addition to BHCCS I responsibilities, can act as a consultant for enhancements to materials and electronic health record improvements to documentation standards.

JOB QUALIFICATIONS

Must have reliable transportation as 60% of the work will be spent in the field serving Clermont, Brown, Adams Counties and potentially Scioto County.

Behavioral Health Care Coordination Specialist I

• High School graduate or equivalent and 3+ years relevant experience OR
• Bachelor's degree with 1-year relevant experience

Behavioral Health Care Coordination Specialist II

• Bachelor's degree and 2+ years' relevant experience and training or Master's degree with 1 year experience in one or more of the following areas-Family systems; Community systems and resources; Case management; Child and Family counseling or therapy; Child protection; Child development.
• May require clinical license, certification or training.

Preferred experience

• Wraparound experience

• Meeting facilitation experience

• Community-based experience

Expected Starting Pay Range:

Behavioral Health Care Coordination Specialist I: $22.18/hr - $27.73/hr

Behavioral Health Care Coordination Specialist II: $23.90/hr - $29.88/hr

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At Cincinnati Children's, we come to work with one goal: to make children's health better. We believe in a holistic team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children's.

Cincinnati Children's is:

• Recognized by U.S. News & World Report as atop 10 best Children's Hospitals in the nation for more than 15 years

• Consistently among the top 3 Children's Hospitals for National Institutes of Health (NIH)Funding

• Recognized as one of America's Best Large Employers (2025), America's Best Employers for New Grads (2025)

• One of the nation'sAmerica's Most Innovative Companiesas noted by Fortune

• Consistently certified as great place to work

• A Leading Disability Employeras noted by theNational Organization on Disability

• Magnet designated for the fourth consecutive time by theAmerican Nurses Credentialing Center (ANCC)

We Embrace Innovation-Together. We believe in empowering our teams with the tools that help us work smarter and care better. That's why we support the responsible use of artificial intelligence. By encouraging innovation, we're creating space for new ideas, better outcomes, and a stronger future-for all of us.

Comprehensive job description provided upon request.

Cincinnati Children's is proud to be an Equal Opportunity Employer committed to creating an environment of dignity and respect for all our employees, patients, and families. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, genetic information, national origin, sexual orientation, gender identity, disability or protected veteran status. EEO/Veteran/Disability