Job Description: BH Clinical Liaison

Employment Type: Full-time

Position Overview

At CVS Health, we are building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. We do it all with heart, each and every day.

Location: Must reside in Virginia. Travel: Potential for up to 10% of travel in the region candidate resides. Schedule: Monday - Friday, 8 AM - 5 PM, with occasional on-call holiday weekend coverage required.

The BH Clinical Liaison is a clinical leader within the Medicaid plan, focusing on utilization management, integrating member care, and clinical coordination. This role leads 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.

Responsibilities

• Clinically manage non-traditional mental health services and addiction recovery and treatment services through the utilization management process.
• Drive 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.
• Consult 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, and behavioral health and human services system issues.
• Support and encourage CM and UM staff to function as an interdisciplinary team, with the requisite range and depth of subject matter expertise to meet the needs of the covered population.
• Represent the 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, identify opportunities for improving rounds, and work with the clinical leadership team to optimize the value of rounds to the clinical staff.
• Demonstrate knowledge about established and evolving biomedical, clinical, epidemiologic, and social-behavioral sciences and the application of this knowledge to member care.
• Participate in/support process improvement initiatives within care management and across broader Plan operations.

Requirements

• Must reside within 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 of experience with the delivery of community-based Medicaid behavioral health services.
• 5+ years of clinical experience in behavioral health, mental health, or psychiatric care.
• 2+ years of experience using a personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).

Preferred Experience

• Experience in completing utilization management tasks.
• Demonstrated leadership competency and strong relationship building skills; 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.