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The Senior Clinical Strategist is a Behavioral Health Leader and Administrator for Aetna Better Health of New Jersey Medicaid Health Plan . The role requires experience and familiarity with Substance Use Disorder (SUDS), Applied Behavioral Analysis (ABA), Trauma Informed Care, Person Centered services, Integrative Care, and Evidenced Based Practices as dictated by the business needs of the plan. The Senior Clinical Strategist functions as the Behavioral Health Subject Matter Expert (SME) for the plan and works across various departments including Care Management, Utilization Management, Quality Management, and Medical Management on issues related to Behavioral Health. Further, the Senior Clinical Strategist functions as the Behavioral Health SME for departments such as Member Services, Provider Relations, Network, and provider Credentialing.Overview

• Lead multiple aspects of New Jersey's Behavioral Health Integration including, but not limited to, host trainings, monitor progress and outcomes, and adapt processes and procedures as necessary
• Support all products including ICM (Integrated Care Management), MLTSS (Medicaid Long Term Support Services), and FIDE (Fully Integrated Dual Eligibility-Medicaid Medicare)
• Coordinates across ICM, MLTSS, and FIDE NJ products to address member Behavioral Health needs and ensure contractual compliance
• Accountable for development, implementation, and ongoing management of complex medical management and clinical operations programs and projects to improve health plan outcomes
• Design conceptual models, initiative planning, business results, stakeholder relationship management and satisfaction for small to moderate scale projects and complex high value initiatives
• Responsible for providing guidance and direction to internal and external stakeholders and/or matrixed staff as required to support initiatives
• Accountable for transferring clinical and operational knowledge, best practices, and methodologies
• Utilizes clinical experience and skills in a collaborative process across the markets to evaluate and facilitate appropriate healthcare services/benefits for members. Gathers, analyzes and synthesizes clinical data to drive achievement of strategic business goals/objectives.
• Acts as an advocate of change while influencing others to see the value in programs/projects, including managing interpersonal sensitivities and articulating the strategic view to ensure project alignment
• Awareness and tracking of state trends including legislative. Develops and executes franchise model policies, procedures, workflows, training materials as needed and modifies to incorporate contract/regulatory requirements for state stakeholders and to meet accreditation needs.
• Participate in all behavioral health meetings with the Division of Medical Assistance and Health Services (DMAHS) and serve as main contact for all day-to-day DMAHS interactions on behavioral health issues

• Active, independent licensure in the state of New Jersey as one of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Clinical Nurse Specialist (CNS), Licensed Clinical Psychologist (LCP) - with experience serving chronically ill populations with mental health and substance use disorders
• New Jersey resident
• 4+ years demonstrated experience in managing large initiatives and projects with demonstrated outcomes
• 4+ years demonstrated experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience in providing behavioral health and Care Management services to include assessments, care planning, interventions, monitoring, reporting
• Proven communication skills both written and verbal and able to communicate effectively with all levels of an organization from C-Suite executives to front-line staff
• Ability to work collaboratively with internal and external teams to build knowledge and improve processes
• Group facilitation/presentation skills that inform and influence internal and external parties
• Experience in successfully building, maintaining, and supporting effective relationships across cross-functional teams to achieve goals

• Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management
• Participate in strategic projects and process improvements based on lessons learned
• Profound understanding of clinical workflows and best practices
• Ability to effectively manage client expectations and inspire confidence