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Behavioral Health Clinical Liaison

Primary Location: Philadelphia, PA
Additional Locations: PA-Philadelphia
The Clinical Liaison is clinical leader in the Medicaid plan focusing on 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 State governments, key stakeholders, community organizations, advocacy groups as well as the Medicaid Plan’s Chief Medical Officer and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.

Fundamental Components:
Partners with Plan leadership team to provide overall vision and direction related to Behavioral health activities ( internal and external) Serves as a key resource regarding any issues related to the integration of member care across departments. 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 including critical stakeholders such as various departments of state government, provider organizations, advocacy organizations, etc. Partners with Aetna Medicaid’s regional psychiatrist(s) to manage and oversee ICM within the health plan. Provides consultation to support physicians at other Medicaid Plans. Participates in organizational planning, including strategic plans, business plans, and new product development. Elicits staff input related to their job functions and leverages errors and failure to reach performance targets as opportunities for organizational learning and improvement. Supports and encourages CM, UM and DM 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, such as state government officials, providers/vendors, & advocacy groups with regard to quality improvement initiatives, integrating member care, health plan success, and innovative care strategies. With the plan’s physician leader, co-facilitates 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. Participate in and support process improvement initiatives within care management and across broader Plan operations.

Background Experience:
  • 5+ years of experience including clinical, supervisory and/or administrative role; Required
  • Experience working in a Pennsylvania Medicaid Health Plan; Strongly Preferred
  • 2+ Previous Leadership, supervisory or management experience; Required.
  • 3+ years complex case work experience; Required, preferably in managed care environment in a community or institutional setting.
  • Experience working with Executive level management; Required
  • Exp in handling mental health and psychiatric care, family situations, and relationship concerns; Required
  • 5+ Experience working with managed and non-managed health care benefits; Preferred
  • Strong verbal and written communication skills and the ability to communicate effectively with all levels of management.
  • Utilization review experience; preferred
  • Experience with third party relationships, including local community building efforts, governmental and regulatory authorities; Preferred
  • Supervisory, management and administrative experience, excellent consultative and communication skills, analytical ability, decisiveness, strong judgment and the ability to work effectively with client and IT management and staff and vendors; Preferred
  • Master’s degree in social work and license (LSW or LCSW) or Licensed Behavioral Health Clinician (LPC, LMFT, PhD, or Psy.D), or RN with current unrestricted state licensure; Required.

Additional Job Information:
Position requires travel to onsite meetings possible through out the state, with relationship BH MCOs and our state regulators. The Clinical Liaison will work with all staff working with members with BH needs for both Medicaid and CHIP.

Required Skills:
General Business - Demonstrating Business and Industry Acumen, General Business - Ensuring Project Discipline, General Business - Turning Data into Information, Leadership - Anticipating and Innovating, Leadership - Collaborating for Results, Service - Working Across Boundaries

Desired Skills:
Benefits Management - Understanding Clinical Impacts, General Business - Communicating for Impact, General Business - Demonstrating Business and Industry Acumen

Functional Skills:
Medical Management - Medical Management - Administration/Management

Technology Experience:
Desktop Tool - Microsoft Word

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. Click here to review the benefits associated with this 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.

Click To Review Our Benefits (PDF)


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