Care Manager - BHT - Impresiv Health
Orange, CA 92868
About the Job
Title: Care Manager – BHT
Duration: up to 6 months
Compensation: $34.66-$55.46
Description: The Care Manager is responsible for the oversight and review of Behavioral Health Treatment (BHT) including 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 BHT services from behavioral health providers. The incumbent is responsible for utilization management, quality reviews and monitoring activities of BHT services. The incumbent will directly interact with providers for care coordination for BHT/ABA services.
What You Will Do:
You Will Be Successful If:
What You Will Bring:
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!
Duration: up to 6 months
Compensation: $34.66-$55.46
Description: The Care Manager is responsible for the oversight and review of Behavioral Health Treatment (BHT) including 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 BHT services from behavioral health providers. The incumbent is responsible for utilization management, quality reviews and monitoring activities of BHT services. The incumbent will directly interact with providers for care coordination for BHT/ABA services.
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.
- Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
- Reviews requests for medical appropriateness.
- Verifies and processes referrals using established clinical protocols to determine medical necessity.
- Screens requests for the Medical Director’s review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director’s decision and documents follow-ups in the utilization management system.
- Completes required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.
- Reviews International Classification of Diseases (ICD-10), Current Procedural Terminology (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and existence of coverage specific to the line of business.
- Performs quality review of submitted documents and ensures the required elements are met by the established protocols, policies and procedures.
- Mails rendered decision notifications to the provider and member, as applicable.
- Adheres 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 and reports timely to appropriate department.
- Stays up to date with federal, state and local regulations that pertain to the BHT benefit.
- Assists with case audits as assigned.
- Completes care coordination activities as assigned.
- Completes other projects and duties as assigned.
You Will Be Successful If:
- Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds
What You Will Bring:
- Master’s degree in psychology, social work, counseling or related field required.
- 4 years of experience providing ABA and or mental health services, including experience in clinical review and treatment plan oversight; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
- Current CA unrestricted license such as LCSW, LPCC, LMFT, RN (with BH experience), Board Certified Behavioral Analyst (BCBA) or Board Certified Behavior Analyst - Doctoral (BCBA-D) required.
- Prior authorization/utilization review experience preferred.
- Managed care experience preferred.
- Post degree ABA experience preferred.
- Quality assurance experience preferred.
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!
Source : Impresiv Health
