Board-Certified Behavior Analyst

Role Overview

• Oversee coverage determinations for ABA utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting
• Conduct or assist with peer-to-peer discussions as appropriate
• Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
• Help Develop specialized Care Management program for members diagnosed with Autism
• Develop and implement training for UM and CM employees on evidence-based treatments for Autism
• Participate in regulatory/accreditation reviews
• Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
• Provider technical assistance to improve quality of services to members with autism and intellectual disabilities
• Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
• Represent CareSource as the primary clinical liaison to members, providers and State agencies
• Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
• Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
• Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
• Collaborate with market/product leaders to help define market strategy
• Community collaborative participation
• Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
• Provide cross-coverage for Behavioral Health Medical Directors and/or markets, as needed
• Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
• Perform any other job related instructions, as requested

Requirements

• Completion of an accredited doctoral program
• Minimum of three (3) years of post-doctoral experience working with people with intellectual or developmental disabilities is required
• Managed care medical review experience is preferred

Benefits

• substantial and comprehensive total rewards package