Behav Health Clinician Rev

Aflac is a Fortune 500 company and an industry leader in voluntary insurance products that pay cash directly to policyholders. We develop and empower our people, cultivate relationships, give back to our community, and celebrate success. This role is remote, based in the continental US, with occasional requests to come to the office as needed.

About the role

As a Behavioral Health Clinician, you will serve as a clinical co-manager on behavioral health claims, providing expertise in analyzing clinical information, negotiating return-to-work plans, and coordinating care. You will act as a resource for claims and clinical staff, ensuring optimal outcomes for employees and employers.

Core Values for Success

• Acting with Integrity
• Communicating Effectively
• Pursuing Self-Development
• Serving Customers
• Supporting Change
• Supporting Organizational Goals
• Working with Diverse Populations

Key Competencies for the Role

• Psychiatric experience and knowledge
• Solid investigative and analytical skills
• Strong customer service skills
• Excellent written and oral communication
• Strong organizational and time management skills
• Ability to analyze behavioral health records in the context of functional capacity
• Maintain active licensing and professional credentials
• Model behaviors that demonstrate commitment to corporate values
• Educate team members and business partners on clinical expertise
• Provide guidance and support for team members

Responsibilities

• Serve as clinical co-manager on behavioral health claims from inception of short-term disability (STD) claims, performing activities requiring clinical expertise, including provider interviews, analyzing clinical information, and negotiating return-to-work plans with employees, treating providers, and employers.
• Review and evaluate disability claims to determine level of functioning based on knowledge of behavioral health conditions, employer and job requirements, and the plan’s definition of disability.
• Investigate and resolve inconsistencies in cognitive, emotional, or behavioral functioning.
• Coordinate strategies to determine true level of functional capacity through direct contact with treating providers or internal clinical resources (e.g., Peer-to-Peer Reviews, impairment guides, round table reviews).
• Review claims from a behavioral health perspective to assess if clinical evidence supports work preclusion, accommodation needs, or restrictions based on vocational demands.
• Document impairment, functional status, and assessments, including behavioral health, contractual, and vocational information.
• Act as a behavioral health consultant to the appeals business unit.
• Serve as a resource for claims and clinical staff handling claimants who may pose a risk of harm to themselves or others.
• Facilitate referrals to collateral internal and external services (e.g., EAP, disease management programs, advocacy) as applicable.
• Monitor response to care and advocate for optimal care when needed.
• Coordinate and monitor the quality of behavioral health Independent Medical Examinations (IMEs).
• Coordinate internal physician consultant referrals using supporting clinical and vocational resources.
• Identify barriers to return-to-work and recommend appropriate healthcare, rehabilitation, and work solutions to facilitate timely return-to-work.
• Communicate effectively with case managers, employers, employees, and healthcare providers.
• Strategize with claimants, treating providers, and employers on possible accommodations or restrictions to facilitate return-to-work.
• Manage daily relations with assigned accounts and key contacts.
• Visit clients for new account implementation and maintenance of existing accounts as required.
• Attend and/or present clinical lectures to educate claim staff as requested.
• Anticipate, recognize, and respond to customer needs to ensure satisfaction.
• Support implementation of customer initiatives to drive best outcomes.
• Review assigned customer cases, prioritize workload, and interpret policies to resolve customer issues within authority limits.
• Provide status updates on co-management plans to ensure clear communication and transparency.
• Resolve technical problems by referring to policies, procedures, and specifications to ensure accuracy and consistency.
• Collect data and prepare clinical reviews, including commentary and analysis to facilitate decision-making.
• Provide detailed procedural advice to internal clients to ensure adherence to clinical co-management standards.
• Input relevant data into established systems accurately for data analysis.
• Perform additional job duties as needed.

Requirements

• Bachelor’s degree in healthcare or a related field (e.g., nursing).
• Master’s degree in Behavioral Health or a related field (e.g., MSW, MA or MS in counseling).
• Minimum of 3 years of experience in behavioral health working with patients.
• Active clinical license (e.g., LCSW, LMHC, LPC, RN) or equivalent.

Preferred Qualifications

• 2+ years of experience in the disability management industry managing claims.
• CDMS or CCM designations.
• Utilization review experience and/or experience using specific behavioral health criteria or protocols.

Travel requirement: ≤ 10%.

Pay

The salary range for this role is $75,000 to $90,000. Offers consider factors such as education, experience, licensure, certifications, geographic location, and peer compensation. This range does not include potential incentive pay or benefits.

Benefits

• Medical, dental, and vision coverage
• Prescription drug coverage
• Healthcare and dependent care flexible spending accounts
• Aflac supplemental policies (Accident, Cancer, Critical Illness, and Hospital Indemnity offered at no cost to employee)
• 401(k) plans
• Annual bonuses
• Opportunity to purchase company stock
• 11 paid holidays annually
• Up to 20 days of PTO for any reason
• State-mandated sick leave (e.g., Washington employees accrue 1 hour of sick leave for every 40 hours worked)
• Other leaves of absence as eligible, including adoption and parental leave, to support physical, financial, and emotional well-being