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The Behavioral Health (BH) Specialist is a field-based position that requires routine travel 80-90% of the time; use of a personal vehicle when traveling in the field. Must have active and valid KY driver's license, reliable transportation and vehicle insurance. Candidate may reside in any of the 9 regions: Jefferson, Two Rivers, SRT, Northern Bluegrass, Northeastern, Southern Bluegrass, Cumberland, The Lakes, or Eastern Mountain. This position utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. The BH Specialist assists in care planning and collaborating with physical health care managers to assure BH enrollee needs are met.
Evaluation of Members:
Enhancement of Medical Appropriateness and Quality of Care:
- Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgeably participate with their provider in healthcare decision-making. Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- 5+ years of behavioral health experience required; BH, social services or appropriate related field equivalent to program focus
- Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavior Health Services, Trauma-informed Care, ACEs, Crisis Intervention Services, and evidence-based practices applicable to the Kentucky SKY populations is required
- Case management and discharge planning experience preferred
- Managed Care experience preferred
- Minimum of a Bachelor's degree or a non-licensed master's prepared clinician is required, with either degree being in behavioral health or human services preferred (social work, psychology, marriage and family therapy, counseling)
- Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel
Additional Job Information
At Aetna Better Health of Kentucky, we reach beyond ensuring access to quality health care by focusing on resilient healing for children and their families. Our vision is to construct local, regional, and state-level coalitions to create a shared, in-common vision of health promoting and resiliency building approaches, to engage and support children to have membership in a family and community, while services and permanency planning are occurring. By keeping families safely together, children in Kentucky SKY will experience less trauma, which leads to better outcomes. To accomplish this, we are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to supporting children, young people, parents, and other important partners involved with child protection systems. We value diversity and are dedicated to helping you achieve your career goals.
Bachelor's degree or equivalent experience
Percent of Travel Required
75 - 100%
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.