Aetna Behavioral Health Specialist in Somerset, New Jersey
Req ID: 55392BR
We are building an exciting new clinical and member experience program at Aetna. Aetna Community Care is a member centric, team-delivered, community based care management model that joins members where they are.
The Behavioral Health Specialist is responsible for leading and implementing behavioral health support, strategies and interventions for high risk Commercial and Medicare members in the Aetna Community Care Program. The Behavioral Health Specialist works within an Interdisciplinary Care Team, and is an expert resource for clinical staff and others. The Behavioral Health Specialist works directly with members, providers and the health care plans behavioral health staff and delivers an integrated medical- behavioral care model that supports holistic member centered care along the health continuum.
Provides expert BH consultative guidance, conducts ICT reviews, and provides education and resources to clinical staff and members
Contributes to the holistic assessment and evaluation of members BH needs, to assure an integrated medical-behavioral plan of care
Participates in the Interdisciplinary Care Team and collaborates with healthcare team to align BH interventions with problems, care plans, goals and interventions.
Documents all assessments, and notes in the Med Compass System.
Evaluates the plan of care and effectiveness and outcomes of BH interventions and modifies, as needed goal attainment, will add new goals or update current ones in the care plan for the Member.
Leverages community services, community resources to support members BH plan of care and well-being.
Provides additional resources to the Program Manager for inclusion the Community Resource Directory.
Coordinates and or Co-Manages with Aetna Behavioral Health and Beacon Health to maximize effective utilization of health plan benefits and network providers
Confers with Members BH providers to gain clarity on the prescribed treatment plan, in order to support member adherence
Analyzes and applies pertinent data, metrics and reports to monitor and enhance quality, productivity, and assure adherence to policy and procedures
Adheres to protocols and processes in compliance with regulatory guidelines and company policies and procedures as outlined in our approved processes.
Identifies/escalates member safety & quality of care issues through established channels that are in accordance with the Procedure, Conduct and Safety for Face to Face Visits, by using the same chain of command for reporting emergency situations.
Documents all communications through Case Logs, Case Notes and Care Plan ,with Members in the Med Compass System and adheres to documentation policies of within 24 hours of member contact
Provides data, and other case information as requested by the Program Manager and other Senior Members of the Leadership Team.
Responds to Program Manager and other members on the Senior Leadership team upon request
Utilizes SharePoint to access all training and program guidance for Aetna Community Care.
Background/ Experience Desired:
Minimum of 3 years of direct clinical practice experience post Masters degree required
Experience working with adult populations, e.g., community, public health, hospital setting, alternative care setting such as home health or ambulatory care required
Local travel may be required
The minimum level of education required for candidates in this position is a Masters' degree
Maintain a comprehensive working knowledge of managed care, payer requirements and network services for target population to maximize benefit to member overall wellbeing
Ability to build relationships and work collaboratively within an inter-disciplinary team model
Crisis intervention skills preferred
Managed care experience preferred
Bilingual (Spanish and/or Creole) preferred.
The highest level of education desired for candidates in this position is a Master's degree.
Active Behavioral health professional license (LCSW, LMHC, or Psychologist or Psychiatric Registered Nurse with a Master's degree) required and in good standing.
Position is work at home; located anywhere in the state of NJ.
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. 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.
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.
Aetna takes our candidates'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
Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.