Aetna Insurance Careers – Regional Transition of Care Coordinator BH

Job Description:

As part of the bold vision to deliver the “Next Generation” of managed care in Ohio Medicaid, Ohio RISE will help struggling children and their families by focusing on the individual with strong coordination and partnership among MCOs, vendors, and ODM to support specialization in addressing critical needs. The OhioRISE Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems.

Job Responsibilities:

• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
• Enhancement of Medical Appropriateness and Quality of Care:
• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.
• lifestyle/behavior changes to achieve optimum level of health.
• Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs.
• Ability to speak to medical and behavioral health professionals to influence appropriate member care.
• Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes
• Identifies and escalates quality of care issues through established channels.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
• Helps member actively and knowledgably participate with their provider in healthcare decision-making.
• Using holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes.
• Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.

Job Requirements:

• Willing and able to travel up to 50% of the time within the assigned region. Must possess reliable transportation, active/valid driver’s license, and proof of vehicle insurance.
• Case management and discharge planning experience.
• Managed care/utilization review experience.
• Unencumbered Behavioral Health clinical license in the state where they work (Ohio). (LPCC/PCC, IMFT, LISW).
• 1+ year(s) of personal computers, keyboard and multiple systems navigation, and MS Office Suite applications.
• 3+ years of direct clinical practice experience post Master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility.
• Experience in one or more of the following areas of expertise: family systems, community systems and resources, case management, child and family counseling/therapy, child protection, or child development.
• Willing and able to work beyond core hours, Monday-Friday, 8am-5pm, as needed.
• Master’s degree in social work, counseling, or marriage and family therapy with an independent practice license in Ohio, LISW, LPCC or IMFT, required.
• 2+ years of experience in children’s mental health, child welfare, developmental disabilities, juvenile justice, or a related public sector human services or behavioral health care field, providing community-based services to children and youth, and their family/caregivers.

Job Details:

Company: Aetna

Vacancy Type:  Full Time

Job Location: Cincinnati, OH, US

Application Deadline: N/A

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