Behavioral Health Clinical Liaison-LISW, LPCC - ...
CVS Pharmacy - Cincinnati, OH
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Job DescriptionThe Behavioral Health Clinical Liaison is a clinical leader in the duals plan focused on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna MyCare Ohio members. FUNDAMENTAL COMPONENTS: The BH Clinical Liaison represents the plan and collaborates with state government, key stakeholders, community organizations, advocacy groups as well as plan leadership to enhance the quality of services provided to Aetna Medicaid members and to ensure adherence to performance targets of the business area. Key functions include but are not limited to: Serves as a Behavioral Health subject matter expert and key resource regarding any issues relating to integration of member care across departments. Drives collaboration on quality of care, utilization management, disparities and care coordination to ensure optimal member outcomes. Consults with executive management regarding physical and behavioral health clinical issues as they relate to medical management (utilization management, care management, quality management) provider and system of care issues, BH and social services system issues including critical stakeholders of various departments within state government, provider and advocacy organizations, etc. Supports and encourages CM, 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 the plan to relevant external stakeholders such as providers/vendors and advocacy groups in regard to quality improvement initiatives, integrating member care, health plan success and innovative care strategies. Participation in and at times facilitation of internal interdisciplinary case rounds to address the needs of members with complex clinical presentations, identifies opportunities for improving rounds and provides input to clinical leadership team to optimize. Supports the plan's ability to comply with Behavioral Health outcomes required by regulators and credentialing bodies (i.e., CMS, ODM, NCQA) Advises on care coordination needs for members during and after inpatient behavioral health admissionsRequired Qualifications 2+ years' experience working for a managed care organization preferred 5+ years advanced clinical management experience in behavioral health Must be willing to travel up to 15% OH Southwest Region: Hamilton, Clermont, Butler, Warren and Clinton counties and surrounding areas LISW or LPCC is requiredCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience with third party relationships including regulators, providers, advocates Experience working with Executive level management desired Knowledge of MyCare Ohio product line and Ohio's behavioral health system desiredFunctional Experiences: Case Management 4-6 years Clinical coverage and policies 4-6 years 1-3 years Managed Care experienceEducationMaster's degree requiredBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
Created: 2024-09-07