ABA Care Management Specialist

Job Description

Job Description

Saginaw County Community Mental Health Authority is seeking a Board Certified Behavior Analyst (BCBA) to serve as a Care Management Specialist. This role is responsible for conducting utilization review, evaluating Applied Behavior Analysis treatment plans, managing level of care assessments, and coordinating care to ensure high-quality behavioral health services. The ideal candidate will apply evidence-based clinical practices, assess medical necessity, ensure Medicaid compliance, and collaborate with multidisciplinary care teams to optimize outcomes for individuals served.

Responsibilities

• Provide preauthorization of behavioral health services based on assessments, medical records, medical necessity, and benefit coverage.
• Review level of functioning assessments including CAFAS, LOCUS, SIS, ASAM, and MichiCANS to determine appropriate level of care placement for mental health and substance use treatment services.
• Utilize multiple electronic health record (EHR) systems while maintaining data integrity and ensuring accurate data interface between systems.
• Conduct concurrent reviews of ABA treatment plans, goals, and community-based services regarding quality, outcomes, fidelity criteria, and service selection guidelines.
• Ensure ABA provider network service activity log (SAL) documentation is targeted, sufficient, and timely, verifying that baseline data and outcome measures are accurately identified.
• Recommend authorization, denial, or reduction of services based on clinical review and participate in multidisciplinary Care Conferences to review adverse decisions and ensure due process and proper notice to individuals served.
• Prepare written justification of service denials with recommendations for alternative resources.
• Issue recommendations for provider payment restitution if documentation in the medical record is insufficient to establish eligibility.
• Analyze utilization data to prepare profile reports and actionable recommendations for primary care providers.
• Conduct provider and community training on care management policies, service selection guidelines, eligibility assessment criteria, intensity of service requirements, and coordination of care standards to reduce service denials.
• Participate in process improvement committees and prepare summaries of findings for supervisory review.
• Stay current with ABA best practices, evidence-based interventions, and commercial or Medicaid payor policies.
• Ensure accurate, timely data entry, coding, report writing, and clear communication of authorization decisions to providers and individuals served.
• Maintain strict confidentiality of protected health information and adhere to all SCCMHA mission, vision, and compliance standards.

Qualifications

• Active, unrestricted Board Certified Behavior Analyst (BCBA) license from an accredited institution.
• Valid Michigan Driver License with a good driving record.
• Minimum of three years of experience writing ABA treatment plans.
• Experience in utilization management, utilization review, or clinical oversight preferred.
• Demonstrated competency in the full array of ABA services and deep knowledge of Medicaid healthcare ABA benefits.
• Strong professional written and verbal communication skills.
• Proven ability to analyze complex data, produce accurate documentation, and work independently with minimal direction.
• Proficiency with electronic health records (EHR) and data entry platforms.
• Ability to build positive professional relationships, manage time effectively, and maintain strict confidentiality.

Working Conditions

• Standard office environment using keyboard, computer workstation, telephone, and headset for extended periods.
• Position requires carrying a pager during business hours.
• May involve local travel to multiple service locations.
• Physical ability to sit, stand, walk for extended periods, and lift or carry up to 20 pounds.

\nCompany Description

Saginaw County Community Mental Health (SCCMHA) is a local, independent, governmental unit serving the greater Saginaw County area, a Community Mental Health Services Program and has been a mental health authority under contract with the Michigan Department of Health and Human Services since October 1, 1997.

In 2021, it was named a Certified Community Behavioral Health Clinic (CCBHC) by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration. As a CCBHC, SCCMHA is a “one stop wellness center” and offers a full range of services that create access to care, stabilizes individuals in crisis and provides the necessary treatment for those with mental illnesses, intellectual/developmental disorders, children/youth with emotional disorders and substance use disorders regardless of their insurance coverage.

SCCMHA is a behavioral health provider but also a specialty network. The network is comprised of organizations that provide professional services, but also housing and other support services and interventions in both office and sitebased locations as well as in the homes of consumers and their families.

Company Description

Saginaw County Community Mental Health (SCCMHA) is a local, independent, governmental unit serving the greater Saginaw County area, a Community Mental Health Services Program and has been a mental health authority under contract with the Michigan Department of Health and Human Services since October 1, 1997.\r\n\r\nIn 2021, it was named a Certified Community Behavioral Health Clinic (CCBHC) by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration. As a CCBHC, SCCMHA is a “one stop wellness center” and offers a full range of services that create access to care, stabilizes individuals in crisis and provides the necessary treatment for those with mental illnesses, intellectual/developmental disorders, children/youth with emotional disorders and substance use disorders regardless of their insurance coverage. \r\n\r\nSCCMHA is a behavioral health provider but also a specialty network. The network is comprised of organizations that provide professional services, but also housing and other support services and interventions in both office and sitebased locations as well as in the homes of consumers and their families.