Senior Clinical Strategist; C; Aetna OhioRISE - BH or Psych

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The OhioRISE (Resilience through Integrated Systems and Excellence) plan is a Medicaid managed care program that provides and coordinates behavioral health care for eligible children and youth. The Senior Clinical Strategist is a Behavioral Health leader for the Aetna state Medicaid plan. This may include Substance Use Disorder (SUDS), Applied Behavioral Analysis (ABA), Trauma Informed Care, Person Centered services and more as dictated by the business needs of the plan.

The Senior Clinical Strategist functions as the Behavioral Health Subject Matter Expert (SME) for the plan and works across various departments including Care Management, Utilization Management, Quality Management, and Medical Management on issues related to Behavioral Health. Further, the Senior Clinical Strategist functions as the Behavioral Health SME for departments such as Member Services, Provider Relations, Network, and provider Credentialing.

Position works closely with the state Executive leadership team related to Behavioral Health and its integration across the state plan.

The Senior Clinical Strategist is an indivisual contributor and serves as the primary point-of-contact with ODM for any state escalations on member issues. The Senior Clinical Strategist position will interface and coordinate all activities with various OhioRISE departments including Utilization Management, Clinical Services, Provider Relations, Member Services, Operations and Network. This position supports the Behavioral Health Clinical Director, Chief Clinical Oversight Officer, Chief Executive Officer, Contract Administrator, and other OhioRISE leaders in working with stakeholders to handle all state escalations on member issues.

They will develop, maintain, and report on the complete inventory of all state escalations on member issues, including capturing all status updates from internal and external sources. The Senior Clinical Strategist will work to ensure timely resolution of member escalation issues and prioritize meeting the clinical needs of our members. This is a fully remote position. Eligible candidates must live and be licensed in Ohio.

Handle all intakes for any state escalations on member issues, including handling all Just Cause cases;
Field and coordinate OhioRISE and CME responses for state member escalations;
Coordinate, prepare for, and faciliti…

Ohio resident Active and unencumbered independent Ohio Behavioral Health License in one of the following - LPCC, LISW, LMFT, or Psychologist Minimum 5 years demonstrated experience in Behavioral Health service delivery or administration Demonstrated experience in the oversight and/or delivery of behavioral health services, care management, or utilization management, including assessments, care planning, interventions, monitoring, reporting, prior authorization, and concurrent review.

Knowledge and experience with public youth serving systems including Child Welfare, Developmental Disabilities, Mental Health and Recovery, Juvenile Justice. Knowledge of, and experience accessing, service, placements, and funding. Proven communication skills both written and verbal and able to communicate effectively with all levels of an organization from C-Suite executives to front-line…