Clinical Liaison

Aetna Inc. Roanoke , VA 24001

Posted 1 week ago

Job Description:

POSITION SUMMARY

The BH Clinical Liaison/BH Coordinator is a clinical leader in the Medicaid plan focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna members. They represent the plan and collaborate with State governments, key stakeholders, community organizations, advocacy groups as well as the Medicaid Plans Chief Medical Officer and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.

Fundamental Components:

  • Partners with Plan executive leadership team to provide overall vision and leadership across all Plan activities.
  • Serves as a key resource regarding any issues related to the integration of member care across departments.

  • Drives collaboration on quality of care, utilization management, disparities and care coordination to ensure optimal member outcomes.

  • Partners with AETNA Community Outreach Team and Health Care Equity Director to develop strategies with key stakeholders to improve integration efforts and optional care delivery to members.

  • Ensures compliance with DHH and other requirements.

  • Consults with Plan executive management regarding physical and behavioral health clinical issues as they relate to medical management (UM, CM, DM) provider and system of care issues, behavioral health and human services system issues including critical stakeholders such as various departments of state government, provider organizations, advocacy organizations, etc.

  • Partners with Aetna Medicaid's regional psychiatrist(s) to manage and oversee ICM within the health plan.

  • Provides consultation to support physicians at other Medicaid Plans.

  • Participates in organizational planning, including strategic plans, business plans, and new product development.

  • Elicits staff input related to their job functions and leverages errors and failure to reach performance targets as opportunities for organizational learning and improvement.

  • Supports and encourages CM, UM and DM staff to function as interdisciplinary team, with requisite range and depth of subject matter expertise to meet the needs of the covered population.

  • Represents Plan to relevant external stakeholders, such as state government officials, providers/vendors, & advocacy groups with regard to quality improvement initiatives, integrating member care, health plan success, and innovative care strategies.

  • With plan's physician leader, co-facilitates interdisciplinary case rounds to address the needs of members with complex clinical presentations, identifies opportunities for improving rounds, and works with the clinical leadership team to optimize the value of rounds to the clinical staff.

  • Demonstrates knowledge about established and evolving biomedical, clinical, epidemiologic and social-behavioral sciences and the application of this knowledge to member care.

  • Participates/supports process improvement initiatives within care management and across broader Plan operations.

BACKGROUND/EXPERIENCE desired:

  • Minimum 5+ years' experience required working for a managed care organization (MCO).
  • Minimum 5+ years clinical experience, clinical and program oversight experience required, preferably in behavioral health, mental health, psychiatric care. Proficiency with MS Office Suite, WORD, Excel, Outlook, etc. and strong keyboard navigation skills are required. Experience with delivery/supervision of community based Medicaid behavioral health services strongly preferred

EDUCATION

The highest level of education desired for candidates in this position is a Master's degree or Bachelor's degree (Registered Nurses) or equivalent experience.

LICENSES AND CERTIFICATIONS

Nursing/Registered Nurse is required or

Mental Health/Licensed Clinical Social Worker is required or

Mental Health/Licensed Independent Social Worker is required or

Mental Health/Licensed Professional Counselor is required

FUNCTIONAL EXPERIENCES

Functional

  • Medical Management/Medical Management

  • Case Management/4-6 Years

Functional

  • Medical Management/Medical Management

  • Managed Care/Insurance Administration/4-6 Years

ADDITIONAL JOB INFORMATION

  • Previous supervisory experience, overseeing a care management team within a managed care and/or health plan setting is required.
  • Demonstrated leadership competency and strong relationship builder; self-motivated and confident making decisions, ability to influence and shape clinical outcomes, a strong clinical consultant.

  • Possesses strong analytical, verbal and written communication skills; demonstrated ability to communicate effectively with all levels of management, including senior leadership. One of the following licenses is required:

  • Licensed and masters prepared behavioral health clinician; i.e., Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC) Strongly preferred.

  • Licensed Professional Counselor (LPC) or

  • Registered Nurse (RN); BSN with strong psych background required.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.


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Clinical Liaison

Aetna Inc.