Care Manager (Bcba)

Title: Care Manager
Duration: Temp - 6 months
Hours: Onsite, M-F 8am-5pm
Compensation: $33.65 - $54.93/hour
Description: The Care Manager is responsible for the oversight and review of Applied Behavior Analysis (ABA) services offered to eligible members. The incumbent will screen, triage, and assess members to determine the appropriate level of care based on medical necessity criteria. The incumbent will review and process requests for authorization of ABA services from behavioral health providers. The incumbent is responsible for utilization management, quality reviews and monitoring activities of ABA services. The incumbent will directly interact with providers.
What You Will Do:

• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• ssists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Reviews and processes requests for authorization of ABA services.
• Performs quality review of submitted documents and ensures the required elements are met by the established protocols, policies and procedures.
• Ensures providers complete accurate evaluations, authorizations and determinations for ABA assessment and services based on established medical necessity criteria.
• Reviews ABA services requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.
• Codes each diagnosis of service and procedures according to established policy and procedure.
• Responsible for mailing rendered decision notifications to the provider and member, as applicable.
• Documents into the electronic medical records system according to CalOptima Health's guidelines and protocols.
• Responsible for adhering to utilization management regulations and processing timeframes.
• Meets productivity and quality of work standards on an ongoing basis.
• Identifies potential quality issues and fraud/waste/abuse.
• Enters and completes data tracking efficiently and accurately
• Stays current on CPT-4 and Health Common procedure Coding System (HCPCS) codes related to ABA services and continually updates knowledge base regarding the codes.

• Stays up to date with federal, state and local regulations that pertain to the ABA benefit.

• Completes other projects and duties as assigned

You'll Be Successful If You:

• Thrive in a team environment, are flexible and adapt well to change
• Successfully manage multiple deadlines in a fast-paced environment
• re a collaborative worker who can partner with a wide variety of stakeholders
• Prepare concise and clear reports
• Work with all levels of staff to identify, and problem solved contracted provider issues
• Work independently with minimal supervision or guidance
• Establish and maintain effective working relationships with leadership and staff
• Communicate clearly and concisely, both orally and in writing
• Utilize computer and appropriate software (Microsoft Office products) and job specific applications/systems to produce correspondence, charts, spreadsheets, and other information applicable to the position

What You Will Bring:

• Master's degree in psychology, counseling, or related field
• Board Certified Behavioral Analyst (BCBA) or Board Certified Behavior Analyst - Doctoral (BCBA-D) required
• 4+ years of ABA therapy required
• 3+ years of experience in clinical review and treatment plan oversight as a credentialed BCBA required
• Previous experience in prior authorization/utilization review in a managed care setting preferred
• Previous experience with Quality Assurance preferred
• Knowledge of:
  
  • Prior authorization review and processes
  • CPT/HCPCS coding for ABA services
  • ICD-10 coding and DSM-5 diagnostic criteria for autism spectrum disorder and other diagnoses
  • Culture and needs of the socially and ethnically diverse population
  • Principles and practice of healthcare, health care systems, and managed care
  • Medi-Cal benefits and regulations
  • Community based organizations, agencies, and community services

About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv!