Behavioral Health Liaison

Behavioral Health Liaison

Requirements

• 3 years of Clinical/Behavioral Health experience required.
• Proficiency with Microsoft Office Suite (Outlook, Teams, Excel, Word, PowerPoint). Ability to navigate multiple system application/databases for daily tasks and keyboarding/typing.
• Licensed Mental Health Counseling, Clinical Social Worker, Marriage and Family Therapist, and/or Licensed Professional Counselor

Responsibilities

• Makes daily/weekly outbound calls to Aetna benefit members in need of behavioral health follow up care from inpatient stays or Emergency Department visits.
• Collaborates with various health management team members to develop specific interventions that will improve members health status, members adherence to care plan, and compliance with coordinated services.
• Support record collection and review of case and medical records for behavioral health quality activities, including root cause analysis of high utilizer of behavioral health services.
• Reviews documentation and evaluates potential quality of care/gap in care issues based on clinical policies and benefit determinations.
• Conducts outbound telephone calls to members regarding service compliance with behavioral health providers.
• Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
• Offers consultant services and education to network providers to improve adherence to HEDIS standards of care and coding.
• Accurately applies review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
• Data gathering requires navigation through multiple system applications.
• Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
• Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information for Quality Management audit purposes or coordination of member services.
• Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
• Condenses complex information into a clear and precise clinical picture while working independently.
• Commands a comprehensive knowledge of complex delegation arrangements, contracts (member and provider), clinical criteria, benefit plan structure, regulatory requirements, company policy and other processes which are required to support the review of the clinical documentation/information.
• Local travel to network provider offices may be required.

Preferred Qualifications

• Case Management/Care Coordination skills preferred.
• Experience within Managed Care preferred.
• Ability to build productive professional relationships and work collaboratively within cross-functional team required.
• Exceptional communication skills (verbal, written) and ability to present information in various settings required.
• Ability to work independently, multitask, prioritize deliverables, and effectively adapt to fast-paced changing environment required.