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Mission of the position: 

The BH Clinical Liaison 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 incumbent 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 incumbent functions as the Behavioral Health SME for departments such as Member Services, Provider Relations, Network, and Provider Credentialing.  This role in the ABHFL plan will focus heavily on the Medicaid Serious Mental Illness (SMI) sub-population.

Overview: 

The BH Clinical Liaison will be a key conduit for Behavioral Health related information as well as Behavioral Health related programming, initiatives, and processes for ABHFL Medicaid members focused on individuals with SMI.  This position is the business owner for both internal and external Behavioral Health related reports and deliverables.  Also, the incumbent may be tasked with creating, updating, revising, or validating Behavioral Health related Policies & Procedures, Standard Operating Procedures, and Desktops as needed.  This position has a critical role in interfacing and liaising with the Medicaid state regulator to address Behavioral Health related issues and concerns and disseminates Behavioral Health related information across the various functional departments as needed related to statewide Medicaid Behavioral Health benefit changes.  Further, the BH Clinical Liaison is a key contributor to Request for Proposals (RFP’s) for both new business and re-bids as it relates to Behavioral Health.  Finally, the BH Clinical Liaison supports the design and implementation of Behavioral Health specific programs and initiatives including Scalable Actions Items (SAIs) focused on ABHFL SMI individuals as well as children diagnosed with Serious Emotional Disturbance (SED).

Core duties:

• Accountable for development, implementation, and ongoing management of complex medical management and clinical operations programs and projects
• Design conceptual models, initiative planning, business results, stakeholder relationship management and satisfaction for small to moderate scale projects and complex high value initiatives 
• Responsible for providing guidance and direction to internal and external stakeholders and/or matrixed staff as required to support initiatives
• Accountable for transferring clinical and operational knowledge, best practices, and methodologies
• Awareness and tracking of state trends including the FL legislative- Develops and executes franchise model policies, procedures, workflows, training materials as needed and modifies to incorporate contract/regulatory requirements for state stakeholders and to meet accreditation needs
• Focus on the SMI FL Membership to ensure effective processes, workflows, and programming promote integrative care coordination and improve health outcomes
• Responsibility for designing and implementing innovative programs & initiatives to reduce IP Admits and Re-admits
• Responsible for monitoring, tracking, and decreasing total cost of care for FL Medicaid High Utilizers
• Collaborate and partner with multiple functional areas (Utilization Management, Care Management, Quality, etc) to ensure delivery of high-quality care management solution to the FL Medicaid SMI
• Form and maintain strong relationships with FL Community Based Organizations (CBOs) and providers who provide services to the FL Medicaid SMI population to improve services to the vulnerable sub-populations
• Aligns with contractual responsibility to build and maintain collaborative relationships with the other FL Medicaid managing entities and community stakeholders
• Responsible for understanding the FL Crisis Continuum of Care and optimizing ABHFL Medicaid members engagement with the Crisis continuum including post-crisis intervention
• Work closely with FL inpatient BH facilities to promote holistic, comprehensive discharge planning and effective transitions of care between levels of care
• Accountable for improving care management, care coordination, and overall health outcomes for ABHFL Medicaid members including children and adolescents
• Work closely with the ABHFL Network team and local FL BH providers to design, implement, and monitor effectiveness of Value Based Contracts
• Work collaboratively with internal and external teams to build knowledge an improve processes
• Group facilitation/presentation skills that inform and influence internal and external parties
• Experience in successfully building, maintaining, and supporting effective relationship across cross-functional teams to achieve goals
• Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management
• Participate in strategic projects and process improvements based on lessons learned
• Profound understanding of clinical workflows and best practices
• Ability to effectively manage client expectations and inspire confidence
• Demonstrated experience in managing large and complex clinical initiatives and projects
• Proven communication skills both written and verbal; able to communicate effectively with all levels of the enterprise
• Work collaboratively with internal and external teams to build knowledge and improve processes; experience in successfully building, maintaining, and supporting effective relationships across cross-functional teams to achieve goals
• Group facilitation/presentation skills that inform and influence internal and external parties

Required Qualifications:

• Unencumbered Licensed Mental Health Clinician in FL (LPC, LCSW, LMHC, or LCP)
• 4+ years’ experience in managing healthcare initiatives and projects or clinical project program management
• 5+ years’ experience working with the FL Medicaid system
• 5+ years’ experience working with individuals with Serious Mental Illness (SMI)
• 5+ years’ behavioral health experience
• Willing and able to travel up to 20% of their time within Miami and surrounding areas for stakeholder meetings and provider relations

Preferred Qualifications:

• Bilingual in Spanish
• Experience in providing or monitoring behavioral health care management services to include assessments, care planning, interventions, monitoring, reporting
• Experience communicating and presenting to C-Suite executives to front-line staff and internal/external parties
• Group facilitation/presentation skills

Education:

• Masters degree in Behavioral/Mental health field required

Pay Range

The typical pay range for this role is:

$72,306.00 - $155,736.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/04/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.