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Job Summary:

Aetna Better Health is Aetna’s Medicaid managed care plan. Backed by over 30 years of experience managing the care of those with a broad array of health care needs, our Medicaid plans have demonstrated that getting the right help when you need it is essential to better health. That’s why Aetna® Medicaid plans include the guidance and support needed to connect our members with the right coverage, resources, and care. We are focused on enhancing quality and population health outcomes while integrating CVS assets to bring accessible healthcare to our members.

The Quality Behavioral Health Manager is a key member of the Aetna Better Health of Florida leadership team and is responsible for the oversight and management of the Behavioral Health Quality team by setting strategic goals and driving initiatives to improve patient outcomes and safety. The Quality Behavioral Health Manager directs the team supporting the coordination of care between the Aetna benefits member, clinical care teams, and providers. This position may include supporting or conducting both live member outreach calls along with provider education initiatives that supports the development of HEDIS interventions to improve mental health wellness and outcomes. The Quality Behavioral Health Manager develops and implements data-driven strategies and interventions that ensure the delivery of time sensitive behavioral health benefits and services for members. This role will direct the analysis and reporting of member data to monitor outreach effectiveness. The Quality Behavioral Health Manager develops and ensures programs support HEDIS, regulatory, and accreditation requirements.

This is a remote position.  Eligible candidates must live in Florida.

Responsibilities include:

• Manage a team of behavioral health liaisons who directly assist members in avoiding and/or closing gaps in care.
• Support, as needed, daily/weekly outbound calls to Aetna benefit members in need of behavioral health follow up care from inpatient stays or Emergency Department visits.
• Collaborate 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. 
• Review documentation and evaluates potential quality of care/gap in care issues based on clinical policies and benefit determinations.
• Work with facilities and providers to ensure they support all member needs to avoid gaps in care and service.
• Develop and lead programs to support contractual requirements for case and record review, including root cause analysis and case and record review of high utilizers of service or members with serious events.
• Accurately apply review requirements to assure case is reviewed by a practitioner with clinical expertise for the issue at hand.
• 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.

Required Qualifications

• Florida resident
• Active, current, and unrestricted Behavioral Health clinical licensure/registry in Florida (one of the following)
  • Licensed Mental Health Counseling
  • Licensed Clinical Social Worker
  • Licensed Marriage and Family Therapist
  • Licensed Professional Counselor
  • Registered Mental Health Counselor Intern
  • Registered Clinical Social Work Intern
  • Registered Marriage and Family Therapist Intern
• 5+ years clinical/behavioral health experience
• 2+ years supervisory/managerial experience
• 3+ years care management experience
• 2+ years HEDIS performance measures
• Ability to build productive professional relationships and work collaboratively within cross-functional teams
• Exceptional communication skills (verbal, written) and ability to present information in various settings
• Ability to work independently, multitask, prioritize deliverables, and effectively adapt to fast-paced changing environment
• Strong analytical and business intelligence acumen
• Exceptional problem solving and decision making skills
• Demonstrated success in leading collaborative teams
• Commitment to personal and team growth with a focus on agility and adaptability

Preferred Qualifications

• Florida Medicaid experience
• Managed care experience
• Knowledge of the regulations, standards, and policies which relate to medical management
• Certified Case Manager (CCM)

Education

Master’s degree

Pay Range

The typical pay range for this role is:

$78,331.50 - $168,714.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/31/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.