Transition of Care Sr. Clinical Strategist - Aetna Better Health of Oklahoma

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Summary

The Transition of Care Sr. Clinical Strategist provides enterprise-level leadership for Oklahoma’s Transitions of Care (TOC) program—setting strategy, governance, and performance expectations to reduce avoidable utilization, improve outcomes, and strengthen transitions across the continuum.

This role designs and scales TOC models (including 48-hour post-discharge outreach standards and follow-up cadence) and leads the development of standard operating procedures, workflows, and care pathways assuring alignment with state contracts, CMS guidance, and regulatory requirements.

This is a hybrid role; candidates must reside within 45–60 minutes of Oklahoma City and be available to work onsite one day per week.

Position Responsibilities

• Provides leadership and oversight for Transitions of Care (TOC) program operations for complex populations by defining standards and performance expectations for integrated behavioral health, physical health, and social service coordination across care settings, consistent with contract requirements.
• Serves as the accountable owner for Transition of Care program compliance, ensuring the organization can demonstrate adherence to contractual, regulatory, and policy requirements during audits, State reviews, Joint Operating Committees (JOC), and governing body forums.
• Establishes and maintains program standards, workflows, documentation requirements, and escalation pathways for high-risk transitions (e.g., inpatient discharge and plan-to-plan movement), and ensures operational teams execute consistently.
• Acts as a senior liaison between community providers and health plan leadership, including State, County, and community agencies, to align TOC requirements, clarify roles, and enable provider and internal teams with program guidance, tools, and standardized pathways.
• Interacts with clinical and senior leaders to discuss TOC program performance, compliance risks, system gaps, and strategic priorities.
• Partners with cross-functional leaders (e.g., Utilization Management, Care Management, Behavioral Health, Engagement Hub) to operationalize required TOC processes, define escalation models, and ensure readiness for complex transitions (e.g., court-ordered treatment, guardianship, specialized behavioral health services).
• Leads standardization and oversight of integrated behavioral and physical health TOC practices, ensuring consistent coordination expectations across primary care, interdisciplinary teams, and downstream providers.
• Collaborates with Provider Services and Network teams in monitoring provider network compliance with state and contractual requirements and identifying gaps or opportunities impacting Transitions of Care delivery.
• Identifies areas of concern related to TOC program administration, workflows, reporting, dashboards, or alert processes and partners with operational leaders to develop and implement corrective actions and mitigation strategies.
• Provides oversight of TOC-related initiatives, pilots, and special projects to ensure alignment with contract requirements, operational readiness, and intended outcomes.
• Participates in and supports training and re-education of staff and providers related to TOC expectations, workflows, escalation models, and integrated care practices, reinforcing role clarity and accountability.
• Facilitate effective interactions with network and community service providers through provider education focused on transitions of care, integrated behavioral and physical health needs, social service coordination, and appropriate utilization.

Leadership & Transitions of Care Accountability

• Serves as a key leader for the Transitions of Care program, partnering with State agencies, local stakeholders, and the provider network to establish program expectations, accountability, and consistent execution of transitions standards across care settings.
• Facilitates system-level change through continued engagement, education, and alignment of stakeholders toward standardized TOC processes and shared accountability models.
• Partners with community programs and providers to identify gaps and opportunities for complex-population transitions, and to support implementation of standardized TOC pathways, referral agreements, and coordination protocols at the system level.