Job Summary:
The Board-Certified Behavior Analyst serves as the clinical lead in developing and implementing evidenced based clinical policies and practices for members with Autism and their families
Essential Functions:
Oversee coverage determinations for ABA utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective settingConduct or assist with peer-to-peer discussions as appropriateAssume 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 AutismDevelop and implement training for UM and CM employees on evidence-based treatments for AutismParticipate in regulatory/accreditation reviewsProvide 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 servicesProvider technical assistance to improve quality of services to members with autism and intellectual disabilitiesAssist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriateRepresent CareSource as the primary clinical liaison to members, providers and State agenciesSupport 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 standardsParticipate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiativesCollaborate with market/product leaders to help define market strategyCommunity collaborative participationParticipate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concernsProvide cross-coverage for Behavioral Health Medical Directors and/or markets, as neededSupport staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetingsPerform any other job related instructions, as requested
Education and Experience:
Completion of an accredited doctoral programMinimum of three (3) years of post-doctoral experience working with people with intellectual or developmental disabilities is requiredManaged care medical review experience is preferred
Competencies, Knowledge and Skills:
Microsoft Word and Excel skillsExcellent communication skills, both written and oralAbility to work well independently and within a team environmentAbility to create strong relationships with Providers and MembersHigh ethical standardsAttention to detailCritical listening and systematic thinking skillsAbility to maintain confidentiality and act in the company’s best interestAbility to act with diplomacy and sensitivity to cultural diversityDecision making/problem solving skillsConflict resolution skillsStrong sense of mission and commitment of time, effort and resources to the betterment of the communities servedAbility to analyze healthcare data from a variety of sources to evaluate physician practice patternsLeadership experience and skills
Licensure and Certification:
Certified by the Behavior Analyst Certification Board as a BCBA-DLicensed Behavior Analyst in state of practice to meet regulatory requirements is required
Working Conditions:
General office environment; may be required to sit or stand for extended periods of timeMay be required to work evenings/weekendsMay be required to travel to fulfill duties of positionCompensation Range:
$94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Fostering a Collaborative Workplace Culture
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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