Behavioral Health Clinical LiaisonPrimary Location: Philadelphia, PA
Additional Locations: PA-Philadelphia Apply
63131Fundamental 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.
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