Crisis and Emergency Services System of Care Administrator (IC) - Aetna Better Health Kentucky - BH or RN

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.

The Crisis and Emergency Services System of Care Administrator is a clinical practitioner who demonstrates knowledge and expertise in supporting an effective crisis services continuum that provides a clear pathway for accessing care and options for how best to meet member needs and connect individuals to care beyond the moment of crisis. The Crisis and Emergency Services Administrator works towards the overarching goals of crisis care which are to reduce the burden on Emergency Departments and Hospitals, reduce the burden on law enforcement and jails and improve access to the right care, at the right time, in the right place. The Crisis and Emergency Services Administrator supports the business by recommending and overseeing the design of prevention, crisis response, and post crisis care strategies. The Crisis and Emergency Services Administrator has the responsibility for leading/managing programs that divert members to the lowest level of care necessary and to link individuals in crisis to supportive services. This is a highly collaborative process that often requires managing relationships across multiple functional areas including strengthening partnerships between the MCO, community, law enforcement, and behavioral health services. This is a fully remote position with some in-state travel required. Eligible candidates must reside in Kentucky.

Identification of crisis response service gaps and development of solutions. Monitor the administration of state specific programs to ensure compliance with required processes, identify staff training needs, and to collect program outcome data. Participate in the review of policies and procedures related to crisis response behavioral and physical health services. Coordinate with health plan staff to secure needed services for individual members in conjunction with health plan staff. Collaborate with Provider Services in monitoring the network to ensure compliance with state/contractual requirements and to identify service gaps in the crisis response network. Identify areas of concern related to program administration and participate in the development and implementation of appropriate corrective action. Participate in training new and existing health plan staff on new programs, member health and service needs, and provider-related processes. Facilitate effective interactions with network and community service providers through provider education on behavioral and physical health, social service needs, and utilization. Engage in prevention strategy development – early engagement in care, crisis prevention planning, outreach and support. Post-crisis care – discharge/release planning, support and coordination, comprehensive outpatient MH and SUD care Strengthen partnership between community, law enforcement and behavioral health services providers. Promotes and delivers suicide prevention and crisis intervention trainings and education. Works on initiatives to decrease need for inpatient hospitalizations, ED diversion. Provides connections and referrals to agencies and organizations to assist with 988 utilization. Works to improve access to behavioral healthcare services for individuals who are experiencing a mental health, substance use or suicidal crisis Works to achieve better health outcomes and improve life for those with acute mental health needs. Oversees co-response initiatives.