Behavioral Health Manager (LMSW OR RN)Aetna Inc. - Detroit, MI
Req ID: 50919BR
Develop, implement, support, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies,
and programs are comprised of utilization management, quality management, network management and clinical coverage and policies. The Clinical Liaison is clinical leader in the Medicaid plan focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna members. They represent the plan and collaborate with State governments, key stakeholders, community organizations, advocacy groups as well as the Medicaid Plans Chief Medical Officer and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.
Fundamental Components but not limited to the following:
Partners with Plan executive leadership team to provide overall vision and leadership across all Plan activities. 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 Medicaids 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 plans 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
3-5 years complex case work experience, perferably in managed care environment in a community or institutional setting. 5-10 years experience in a clinical (RN or MLSW) setting. Exp in handling behavioral/mental health and psychiatric care, family situations, relationship concerns. Experience working with managed and non-managed health care benefits. Experience with third party relationships, including local community building efforts, governmental and regulatory authorities. Experience working with Executive level management required. 5 years staff management experience 5-10 employees. 5 years of managed care experience (MCO). 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. Managed care/utilization review experience preferred Strong verbal and written communication skills and the ability to communicate effectively with all levels of management. Management experience in a clinical setting desired. For Clinical Services Managers in other areas: 5 years experience including clinical, supervisory and/or administrative role
The highest level of education desired for candidates in this position is a Master's degree.
LICENSES AND CERTIFICATIONS
One of the following:
LMSW (Licensed Masters Social Worker) required w/Behavioral Health OR Registered Nurse w/Behavioral Health required
Healthcare Management/ is desired
Managed Care/ is desired
Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years
Functional - Clinical / Medical/Concurrent review / discharge planning/1-3 Years
Functional - Project Management/Cross-functional project management/1-3 Years
Functional - Communications/Member communications/1-3 Years
Functional - Information Management/Microsoft Internet Explorer/1-3 Years
Technical - Remote Access/Cisco VPN (hardware and software suite)/1-3 Years/End User
Technical - Telecommunications/Network Operations/1-3 Years/End User
Technical - Reporting Tools//1-3 Years/End User
Flexible telework / office-based schedule. (must live in or near service area in Southern Michigan)
ADDITIONAL JOB INFORMATION
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.
We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.
Together we will empower people to live healthier lives.
Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
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.
Job Function: Health Care
24 days 11 hours ago
applyBehavioral Health Manager (LMSW OR RN) Aetna Inc. - Detroit, MI, United States
Aetna Inc. operates as a diversified health care benefits company in the United States. The company operates in three segments: Health Care, Group Insurance, and Large Case Pensions. The Health Care segment provides medical, pharmacy benefit management, dental, behavioral health, and vision plans on an insured basis, and an employer-funded or administrative basis. This segment also provides Medicare and Medicaid products and services, as well as other medical products, such as medical management and data analytics services, medical stop loss insurance, workers' compensation administrative services, and products that provide access to its provider networks in select markets. This segment offers its products and services to multi-site national, mid-sized, and small employers, as well as individual customers. The Group Insurance segment provides life insurance products comprising group term life insurance, voluntary spouse and dependent term life insurance, group universal life, and accidental death and dismemberment insurance; disability insurance products; and long-term care insurance products, which offer benefits to cover the cost of care in private home settings, adult day care, assisted living, or nursing facilities. This segment provides insurance products principally to employers that sponsor its products for the benefit of their employees and their employees dependents. The Large Case Pensions segment manages various retirement products, including pension and annuity products for tax-qualified pension plans. The companys customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna Inc. was founded in 1853 and is headquartered in Hartford, Connecticut.
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