Clinical Case Manager - Behavioral Health Clinical Liaison; LCSW or LCPC

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The remote Behavioral Health Clinical Liaison is a clinical leader in the duals plan focused on integrating member care and clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna Better Health Premier Plan MMAI (Illinois).

The BH Clinical Liaison represents the plan and collaborates with state government, key stakeholders, community organizations, advocacy groups as well as plan leadership to enhance the quality of services provided to members and to ensure adherence to performance targets of the business area. Key functions include but are not limited to:

• Serves as a Behavioral Health (BH) and Substance Use Disorder (SUD) subject matter expert and key resource regarding any issues relating to integration of member care across departments.
• Displays comprehensive understanding of Bio-Psycho-Social principles and practices as they apply across all domains of health care. This includes the ability to apply BH and SUD knowledge, skills, tools and resources to effectively impact three potential areas of opportunity:
• Physical Health and Behavioral Health co-morbidity: co-occurrence of mental disorders and/or substance use disorders when physical health disorders are named as the primary diagnosis
• Psychosocial complexity that creates barriers to member/family engagement with, participation in and adherence to effective health practices
• Difficult relationships between members/families and their health care providers on the one hand, and/or with their care managers on the other, that undermine their ability to collaborate to manage complex, recurring, enduring and disabling health conditions
• Possesses fundamental knowledge of principles of substance use disorder and addiction medicine including ASAM levels of care. This includes ability to communicate with members based on a medical understanding of substance use disorders in a manner that is respectful, non-judgmental, non-stigmatizing, and encouraging. Motivational interviewing skills are a plus.
• Drives collaboration on quality of care, utilization management, disparities, and care coordination to ensure optimal member outcomes.
• Consults with management regarding physical and behavioral health clinical issues as they relate to medical management (utilization management, care management, quality management) provider and system of care issues, BH and social services system issues including critical stakeholders of various departments.
• Represents the plan to relevant external stake holders, such as providers/vendors and advocacy groups regarding quality improvement initiatives, integrating member care, health plan success and innovative care strategies.
• Engages members with complex clinical presentations, identifies opportunities for improving rounds and provides input to clinical leadership team to optimize.
• Supports the plan's ability to comply with Behavioral Health and Substance Use outcomes required by regulators and credentialing bodies (i.e., CMS, ODM, NCQA).
• Advises on care coordination needs for members during and after inpatient behavioral health and substance use disorder admissions.
• This position requires an individual who is an effective leader as well as organized, individually motivated, and accountable.

• 5+ years advanced clinical management experience in behavioral health
• Candidate must have active and unrestricted Licensed Clinical Social Worker (LCSW) or Licensed Clinical Professional Counselor (LCPC) in state of residence

• Certified Alcohol and Drug Counselor (CADC) certification
• 2+ years of experience working for a managed care…