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Behavioral Health Transitions of Care Coach

Primary Location: Toledo, OH
Additional Locations: OH-Toledo
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Description:
The Behavioral Health Transitions of Care (BHTOC) Coach position will facilitate provider and member outreach to ensure member receipt of important clinical services to improve the member’s health outcomes. Provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives and regulatory/contractual requirements by preventing readmissions.

The BHTOC coach will engage in onsite facility visits during the member’s psychiatric hospitalization in their assigned region (NW- Toledo, SW- Cincinnati, and Central- Columbus). The coach will build relationships with the facility and educate them on the resources and benefits Aetna offers as a partner. The coach will also utilize motivational interviewing to engage the member and identify potential barriers to a successful discharge and potential risks to readmission.

The BHTOC coach will utilize 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.

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.

Key functions include:
  • Engaging 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.
  • Ensuring 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.

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

  • 40-50% of local travel required.


Background Experience:
  • 3+years of direct clinical practice experience post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility required
  • RN, LPC, or LSW license required
  • 1+ years in case management, disease management, managed care or medical or behavioral health settings required
  • Experience working with the severly mentally ill population strongly preferred
  • Sedentary work involving periods of sitting, talking, listening.
  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding Managed care/utilization review experience preferred Unencumbered Behavioral Health clinical license in the state where they work
  • Knowledge of or experience using the Care Transitions Intervention or similar model; background in discharge planning and/or home health.
  • Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.


Functional Skills:
Medical Management - Medical Management - Case Management, Nursing - Mental Health

Technology Experience:
Operating System - Windows

Education:
Mental Health - Licensed Professional Counselor, Mental Health - Licensed Social Worker, Nursing - Registered Nurse

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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