• Job Description

  Req#: R0585788

  At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

  As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

  Position Summary

  The Behavioral Health Liaison directs coordination of care between the Aetna benefits member, clinical care teams, and providers. The Behavioral Health Liaison conducts 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 Behavioral Health Liaison develops and implements data-driven strategies and interventions that ensure the delivery of time sensitive behavioral health benefits and services for members. This role takes part in the analysis and reporting of member data to monitor outreach effectiveness. The Behavioral Health Liaison reviews documentation and interprets data obtained from clinical records or internal systems to apply appropriate clinical criteria and policies in line with HEDIS, regulatory, and accreditation requirements. This position coordinates behavioral health care and other needs with internal/external clinician support as required including working with the Care Management and Utilization Management teams.

  Additional responsibilities include but not limited to the following:

  - 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.

  Required Qualifications

  - 3 years of Clinical/Behavioral Health experience required.

  - Must Reside in Florida

  - 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

  Preferred Qualifications

  - Bilingual - Spanish

  - Case Management/Care Coordination skills

  - Experience within Managed Care

  - 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.

  Education

  Master’s degree in Behavioral Health/related fields or equivalent professional experience.

  Anticipated Weekly Hours

  40

  Time Type

  Full time

  Pay Range

  The typical pay range for this role is:

  $54,095.00 - $116,760.00

  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.
  

  Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

  Great benefits for great people

  We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

  For more information, visit https://jobs.cvshealth.com/us/en/benefits

  We anticipate the application window for this opening will close on: 06/13/2025

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

• About the company

  At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

Notice