Senior Clinical Strategist - Aetna OhioRISE - BH or Psych

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Position Summary

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.

Overview: The Senior Clinical Strategist serves as the primary point-of-contacts with ODM for any state escalations on member issues. This 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.

Core Responsibilities:

• 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 facilitate any meetings with internal and external stakeholders;

• Serve as the OhioRISE Plan's point of contact for all state member escalations, including but not limited to: 

• Identifying Aetna and CME contacts to work on any member escalations;

• Coordinating the development and submission of any responses for the OhioRISE to ODM;

• Coordinating OhioRISE Plan's representation and attendance for any meetings related to state escalations on member issues;

• Working with internal and external stakeholder to coordinate and oversee all member transition activities for any members escalated by the state escalations to ensure the safe, timely, and orderly transition of members and their care;

• Creative problem-solving with community partners to meet the needs of at-risk youth;

• Provides clinical expertise in the interdisciplinary team, with requisite range and depth of subject matter expertise to meet the needs of the covered population;

• Assisting community stakeholders, providers, CMEs, and OhioRISE Care management staff with complex cases;

• Coordinating the development and submission of any required reporting on any state escalations on member issues.

Required Qualifications

• 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 providing behavioral health and care management services to include assessments, care planning, interventions, monitoring, reporting or managed care utilization management to include prior authorization, concurrent review

• Knowledge and