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Requisition Job Description
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Must reside in Virginia.
Potential for up to 10% of travel in region candidate resides.
Schedule: Monday- Friday 8-5 with occasional on call holiday weekend coverage required.
The BH Clinical Liaison is a clinical leader in the Medicaid plan focusing on utilization management, 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 internal partners, community organizations, and behavioral health and ARTS providers to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.
Fundamental Components:
- Clinically manage non-traditional mental health services and addiction recovery and treatment services through the utilization management process
- Drives collaboration on quality of care, utilization management, disparities and care coordination to ensure optimal member outcomes.
- Outreach to high utilizers to support treatment coordination, transitions of care, and appropriate discharge planning
- Serve as the behavioral health subject matter expert to support care management staff in serving Aetna members in the respective region
- Interface with community stakeholders to foster collaboration and provide education and training
- 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
- Supports and encourages CM and UM 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, providers/vendors, & advocacy groups with regard to quality improvement initiatives, integrating member care, health plan success, and innovative care strategies.
- Participate in 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.
- Must reside within the Virginia.
- One of the following licenses in the state of Virginia is required: LPC, LCSW, LMFT, BCBA, LBA, or an RN with 5+ years of behavioral health experience
- 2+ years experience with delivery of community-based Medicaid behavioral health services
- 5+ years clinical experience in behavioral health, mental health, psychiatric care
- 2+ years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
- Experience in completing utilization management tasks
- Demonstrated leadership competency and strong relationship builder; self-motivated and confident making decisions
- Ability to influence and shape clinical outcomes, a strong clinical consultant
- Demonstrated ability to communicate effectively with all levels of management, including senior leadership.
- Ability to work independently
- 2+ years experience required working for a managed care organization (MCO).
- If an LPC, LCSW, LMFT, BCBA, LBA, a Master's degree in behavioral health field is required
- If an RN, Bachelor's degree is required
The typical pay range for this role is:
$80,340.00 - $173,040.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit Benefits | CVS Health
We anticipate the application window for this opening will close on: 11/29/2024
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.