ABA Care Management Specialist - BCBA

ABA Care Management Specialist - BCBA

Pay Grade: $72,102.15 - $89,883.67 Annually

$10,000 Recruitment Bonus for Clinical Master level new hires!! (First installment paid at start, second installment paid after 3 months, and third installment paid after successful probation period.)

General Statement Of Duties:

Under supervision of the Director of Utilization Management and Care Authorizations, monitors appropriate uses of Saginaw County Community Mental Health Authority (SCCMHA) resources for applied behavioral health (ABA) treatment and support of individual episodes of care, coordination of care and adequacy of supports and services to sustain outcomes. This position uses best practices derived from scientific evidence to bring together health care resources from across the continuum of care in the most appropriate, effective, and efficient manner to care for the person served. This position will be knowledgeable about and actively support culturally competent recovery-based practices; person centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid persons served in the recovery process.

Essential Duties And Responsibilities:

• Provides preauthorization of services based on review of assessments and the medical record for evidence of medical necessity and within the definition of the benefit.
• Reviews level of functioning assessments including CAFAS, LOCUS, SIS, ASAM, MichiCANS and others as implemented by SCCMHA and decides on appropriate level of care placement for mental health and substance use treatment services.
• Works in multiple electronic health record systems with the ability to ensure data integrity and accurate data interface between systems.
• Provides concurrent review of ABA treatment plans/goals/community-based services regarding quality, outcomes, and fidelity criteria; works as a team member with utilization management tasks related to management of the entire behavioral health benefit.
• Ensure ABA provider network SAL documentation is targeted, sufficient, and timely; ABA targets/goals accurately identify baseline data as well as outcome and new targeting measures as plans change.
• Through concurrent review, may recommend the denial of authorization or reauthorization of service or may suggest reduction in the quantity or duration of services. If reduction or denial of service is recommended, will review the proposed reduction or denial in multidisciplinary Care Conference.
• Prepare written justification of denial with suggestions for alternative resources when denying services through preauthorization review or concurrent utilization review documentation.
• May issue recommendation for provider restitution of payments if documentation of eligibility is not complete or adequate to support eligibility certification in the medical record.
• Prepares individual utilization profile analysis reports and makes recommendations for primary care providers. Profile preparation includes data analysis, record review and written analysis and recommendations.
• Conduct provider training in Care Management Policies and procedures, service selection guidelines, eligibility assessment criteria, severity of illness/intensity of service requirements, coordination of care standards, service protocols and utilization management performance indicators. Training may also be provided to other groups including Citizens Advisory Committee, community groups and others as requested by the Director of Utilization Management and Care Authorizations.
• Participates in multidisciplinary Care Conference for the review of all adverse decisions and individual and provider profile review and related care management performance indicators.
• Participates in process improvement committees as assigned, including preparation of summaries of findings for review by supervisory staff.
• Stay current with ABA best practices and commercial payor policies.
• Is responsible for accurate and timely codification and entry of data and writing of reports, communication of decisions to providers and persons served.
• Preserves confidentiality of information accessed in performance of assigned duties.
• Uses supervision to resolve areas of performance concerns and to facilitate professional growth and development.
• Adheres to the mission, vision, core values and operating principles of SCCMHA at all times.

Incidental Duties And Responsibilities:

• Works closely with and coordinates efforts with those of information systems and administrative staff.
• May attend meetings; make presentations to groups and/or in-service personnel or contractors.
• May attend workshops, seminars, or meetings, read journals, periodicals, and research subjects on the Internet to maintain professional proficiency and disseminate information.
• Must react productively to change and handle other essential tasks as assigned.

Reporting Relationships:

Reports To: Care Management Supervisor

Supervises: None

Working Conditions/Environment:

Works in an office environment with normal time constraints and pressures. Uses a workstation, keyboard and views a computer screen for long periods, uses telephone and headset. Carries a pager during business hours. May involve travel to multiple service locations.

Qualifications:

Education: Active, unrestricted Behavioral Certified Behavioral Analyst (BCBA) licensure from an accredited school required.

Experience: A minimum of three (3) years ABA treatment plan writing experience required; utilization management review/oversight experience preferred.

Licenses And Certifications: Valid Michigan Driver's license with a good driving record.

Active, unrestricted Behavioral Certified Behavioral Analyst (BCBA) licensure from an accredited school required.

Knowledge, Skills, And Abilities:

1. Demonstrated competency in scope of full ABA service array.

2. Posses' knowledge of healthcare Medicaid ABA benefits.

3. Professional level verbal and written communication skills.

4. Ability to produce accurate and comprehensive work products with minimal direction.

5. Ability to exercise mature judgment and maintain strict confidentiality.

6. Ability to maintain favorable interpersonal working relationships and positive public relations.

7. Ability to plan and organize work, perform tasks consistently and adhere to priorities.

8. Ability to provide small group leadership.

Physical/Mental Requirements:

1. Hearing acuity to converse in person and on telephone.

2. Visual Acuity to observe persons served behavior, read and proofread documents and use CRT.

3. Ability to walk, stand or sit for extended periods of time.

4. Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)

5. Ability to lift and carry files and supplies at least 20 pounds.

6. Strong interpersonal skills to interact with leadership, employees, persons served and the general public.

7. Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action.

8. Ability to plan short and long range and to manage and schedule time.

9. Ability to handle stress in meeting deadlines and dealing with large numbers of employees and/or persons served.

(Listed qualifications are for guidance in filling this position. Any combination of education and experience that provides the necessary knowledge, skills, and abilities will be considered; however, mandatory licensing or certification requirements cannot be waived. Physical/mental requirements cannot be waived unless specifically indicated.)