Senior Clinical Strategist – Ohiorise

Senior Clinical Strategist – Ohiorise

Requirements

• 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 experience with public youth serving systems including Child Welfare, Developmental Disabilities, Mental Health and Recovery, Juvenile Justice.
• Knowledge of, and experience accessing, service, placements, and funding.
• Proven communication skills both written and verbal and able to communicate effectively with all levels of an organization from C-Suite executives to front-line staff
• Work collaboratively with internal and external teams to build knowledge and improve processes
• Group facilitation/presentation skills that inform and influence internal and external parties
• Experience in successfully building, maintaining, and supporting effective relationship across cross-functional teams to achieve goals
• Deep knowledge of Medicaid services in Ohio to multisystem involved youth
• Understanding and experience working with Ohio Department of Medicaid
• Willing and able to travel in-state up to 10% of the time with a personal vehicle. Mileage is reimbursed per our company expense reimbursement policy.

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.

Preferred Qualifications

• Ability to manage multiple timelines and produce evidence of driving toward success with regular updates on progress in all areas of clinical project or program management
• Participate in strategic projects and process improvements based on lessons learned
• Profound understanding of clinical workflows and best practices
• Ability to effectively manage client expectations and inspire confidence
• Demonstrated experience in managing large and complex clinical initiatives and projects
• Proven communication skills both written and verbal; able to communicate effectively with all levels of the enterprise
• Work collaboratively with internal and external teams to build knowledge and improve processes; experience in successfully building, maintaining, and supporting effective relationships across cross-functional teams to achieve goals
• Group facilitation/presentation skills that inform and influence internal and external parties