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Behavioral Health Transitions of Care Coach

Primary Location: Cincinnati, OH
Additional Locations: OH-Cincinnati
Engage the member at the start of hospital admission and continues oversight through transitions from the acute setting to all other settings, including nursing facility placement and private home, with the goal of reduced readmissions within 30 days.

Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating as needed or at the request of the member with hospitalists, outpatient providers, facility staff, Aetna care manager and family/support network.

Ensures member transitions to a setting with adequate caregiving and functional support, as well as medical and medication oversight as required. Works with participating ancillary providers, public agencies or other identified service providers to make sure necessary services are in place for a safe transition.

Conducts face-to-face visits of all members while in the hospital, and at home visits of high-risk members post-discharge as needed.

Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus.

40-50% local travel required within region SW corner of Ohio. Standard business hours Monday-Friday. No nights, no weekends and no holidays.

Fundamental Components:
Utilizes clinical experience and skills in a collaborative process to assess the appropriateness of treatment plans across levels of care, apply evidence-based standards and practice guidelines to treatment where appropriate. Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Provides triage and crisis support. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage. determination/recommendation along the continuum of care facilitates including effective discharge planning. Coordinates with providers and other parties to facilitate optimal care/treatment. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Background Experience:
3+ years of direct clinical practice experience working with people who have been designated as having a serious mental illness (SMI) and working with people who are elderly or have a physical disability is required.
3+ years in case management, disease management, managed care or medical or behavioral health settings.
Experience in the behavioral health within hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone and typing into the computer Crisis intervention skills preferred Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Managed care/utilization review experience preferred

Unencumbered Behavioral Health clinical license active & unrestricted in the state of Ohio where they work or Registered Nurse with Behavioral Health experience/background.
Minimum of a Bachelor's degree in Behavioral/Mental health or Human Service/Health Services (as applicable to hiring program) or
Must have valid driver's license with a good driving record and be able to drive within applicable state or locality with reliable transportation.

Additional Job Information:
Completion of an accredited Registered Nurse (RN) Program OR Bachelor's or Master's Degree in social science, psychology, gerontology, public health or social work or related field.

A minimum of a bachelor's degree is required

Potential Telework Position:

Percent of Travel Required:
25 - 50%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate'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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