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Behavioral Health Liaison

8 hours ago

Tallahassee, Florida, United States CVS Health Full time

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.

Behavioral Health Liaison, Quality Management Department

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.

Position Responsibilities

  • 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.
  • Local travel to network provider offices may be required.
  • 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.

Background/Experience

  • Three to five years of Clinical/Behavioral Health experience required.
  • Case Management/Care Coordination skills preferred.
  • Experience within Managed Care preferred.
  • 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.
  • Proficiency with Microsoft Office Suite (Outlook, Teams, Excel, Word, PowerPoint). Ability to navigate multiple system application/databases for daily tasks and keyboarding/typing.

Education
The minimum level of education for candidates in this position is a Master's degree in Behavioral Health/related fields or equivalent professional experience.

Licenses/Certifications

  • Licensed Mental Health Counseling
  • Licensed Clinical Social Worker
  • Licensed Marriage and Family Therapist
  • Licensed Professional Counselor

Additional Job Information
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range
The Typical Pay Range For This Role Is
$54, $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

We anticipate the application window for this opening will close on: 01/13/2026

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