Senior Clinical Strategist / Behavioral Health Lead - Aetna Better Health of New Jersey

liarity with Substance Use Disorder (SUDS), Applied Behavioral Analysis (ABA), Trauma Informed Care, Person Centered services, Integrative Care, and Evidenced Based Practices 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.Overview

The Senior Clinical Strategist is a key conduit for Behavioral Health related information as well as Behavioral Health related programming, initiatives, and processes. This position is the business owner for both external and internal Behavioral Health related reports and deliverables. Also, the incumbent may be tasked with updating, revising, validating, or creating Behavioral Health related Policies & Procedures, Standard Operating Procedures, and Desktops as needed. This position has a critical role in interfacing and liaising with the Medicaid state regulator to address Behavioral Health related issues and concerns and disseminates Behavioral Health related information across the various functional departments as needed related to statewide Medicaid Behavioral Health benefit changes. Further, the Senior Clinical Strategist is a key contributor to Request for Proposals (RFP's) for both new business and re-bids as it relates to Behavioral Health. Finally, the Senior Clinical Strategist supports the design and implementation of Behavioral Health specific programs and initiatives including Scalable Actions Items (SAIs).Core Responsibilities

• Lead multiple aspects of New Jersey's Behavioral Health Integration including, but not limited to, host trainings, monitor progress and outcomes, and adapt processes and procedures as necessary
• Support all products including ICM (Integrated Care Management), MLTSS (Medicaid Long Term Support Services), and FIDE (Fully Integrated Dual Eligibility-Medicaid Medicare)
• Coordinates across ICM, MLTSS, and FIDE NJ products to address member Behavioral Health needs and ensure contractual compliance
• Accountable for development, implementation, and ongoing management of complex medical management and clinical operations programs and projects to improve health plan outcomes
• Design conceptual models, initiative planning, business results, stakeholder relationship management and satisfaction for small to moderate scale projects and complex high value initiatives
• Responsible for providing guidance and direction to internal and external stakeholders and/or matrixed staff as required to support initiatives
• Accountable for transferring clinical and operational knowledge, best practices, and methodologies
• Utilizes clinical experience and skills in a collaborative process across the markets to evaluate and facilitate appropriate healthcare services/benefits for members. Gathers, analyzes and synthesizes clinical data to drive achievement of strategic business goals/objectives.
• Acts as an advocate of change while influencing others to see the value in programs/projects, including managing interpersonal sensitivities and articulating the strategic view to ensure project alignment
• Awareness and tracking of state trends including legislative. Develops and executes franchise model policies, procedures, workflows, training materials as needed and modifies to incorporate contract/regulatory requirements for state stakeholders and to meet accreditation needs.
• Participate in all behavioral health meetings with the Division of Medical Assistance and Health Services (DMAHS) and serve as main contact for all day-to-day DMAHS interactions on behavioral health issues

Required Qualifications

• Active, independent licensure in the state of New Jersey as one of the following: Licensed Clinical Social Worker (LCSW), Registered Nurse (RN), Clinical Nurse Specialist (CNS), Licensed Clinical Psychologist (LCP) - with experience serving chronically ill populations with mental health and substance use disorders
• New Jersey resident
• 4+ years demonstrated experience in managing large initiatives and projects with demonstrated outcomes
• 4+ years demonstrated experience in managed care Utilization Management to include prior authorization, concurrent review OR demonstrated experience in providing behavioral health and Care Management services to include assessments, care planning, interventions, monitoring, reporting
• 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
• Ability to 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 relationships across cross-functional teams to achieve goals

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

Education

Master's degree in behavioral health field; or Registered Nurse (BSN preferred)

ersPay Range

The typical pay range for this role is:$104,442.00 - $224,952.00This 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 HealthWe anticipate the application window for this opening will close on: 01/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.