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CVS Health Clinical Liaison in Falls Church, Virginia

Job Description

Must be located in Northern Virginia.Approximately 50-75% of field based travel required once COVID restrictions are lifted.Standard business hours are required Monday-Friday.The Clinical Liaison is clinical leader in the Medicaid plan focusing on integrating member care, clinical coordination, leading the development, implementation and ongoing monitoring of program and quality initiatives to address the needs of Aetna members. They represent the plan and collaborate with State governments, key stakeholders, community organizations, advocacy groups as well as the Medicaid Plan’s Chief Medical Officer and leadership team to enhance the quality of services provided to Aetna members and to ensure adherence to performance targets of the business area.- Partners with Plan executive leadership team to provide overall vision and leadership across all Plan activities.- Serves as a key resource regarding any issues related to the integration of member care across departments- Consults with Plan executive management regarding physical and behavioral health clinical issues as they relate to medical management (UM, CM, DM) provider and system of care issues, behavioral health and human services system issues including critical stakeholders such as various departments of state government, provider organizations, advocacy organizations, etc.- Partners with Aetna Medicaid’s regional psychiatrist(s) to manage and oversee ICM within the health plan.- Provides consultation to support physicians at other Medicaid Plans.- Participates in organizational planning, including strategic plans, business plans, and new product development.-Elicits staff input related to their job functions and leverages errors and failure to reach performance targets as opportunities for organizational learning and improvement.- Supports and encourages CM, UM and DM staff to function as interdisciplinary team, with requisite range and depth of subject matter expertise to meet the needs of the covered population.- Represents Plan to relevant external stakeholders, such as state government officials, providers/vendors, & advocacy groups with regard to quality improvement initiatives, integrating member care, health plan success, and innovative care strategies.- With the plan’s physician leader, co-facilitates interdisciplinary case rounds to address the needs of members with complex clinical presentations, identifies opportunities for improving rounds, and works with the clinical leadership team to optimize the value of rounds to the clinical staff.- Demonstrates knowledge about established and evolving biomedical, clinical, epidemiologic and social-behavioral sciences and the application of this knowledge to member care.- Participate in and support process improvement initiatives within care management and across broader Plan operations.

Required Qualifications

-CDE or CDCES required or must obtain certification within 90 days of hire-Strong verbal and written communication skills and the ability to communicate effectively with all levels of management required

Preferred Qualifications

-5+ years of management care experience preferred-Managed care/utilization review experience preferred-3+ years of complex case work experience preferred, preferably in managed care environment in a community or institutional setting-RN license highly preferred


Bachelor's degree or equivalent experience

Business Overview

At 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.