ABA Care Management Specialist - BCBA

Saginaw County Community Mental Health Authority•Saginaw, MI

2d•$72,102 - $89,884

About The Position

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. Specific duties in utilization review may be assigned within individual staff scope of practice and target population expertise. Performs responsibilities and tasks with a demeanor and attitude that promotes goodwill, builds positive relationships, communicates respect for human dignity, and contributes positively to the mission and values of SCCMHA. 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.

Requirements

Active, unrestricted Behavioral Certified Behavioral Analyst (BCBA) licensure from an accredited school required.
A minimum of three (3) years ABA treatment plan writing experience required
Valid Michigan Driver’s license with a good driving record.
Demonstrated competency in scope of full ABA service array.
Posses’ knowledge of healthcare Medicaid ABA benefits.
Professional level verbal and written communication skills.
Ability to produce accurate and comprehensive work products with minimal direction.
Ability to exercise mature judgment and maintain strict confidentiality.
Ability to maintain favorable interpersonal working relationships and positive public relations.
Ability to plan and organize work, perform tasks consistently and adhere to priorities.
Ability to provide small group leadership.
Hearing acuity to converse in person and on telephone.
Visual Acuity to observe persons served behavior, read and proofread documents and use CRT.
Ability to walk, stand or sit for extended periods of time.
Manual dexterity to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)
Ability to lift and carry files and supplies at least 20 pounds.
Strong interpersonal skills to interact with leadership, employees, persons served and the general public.
Analytical skills necessary to conduct research, analyze, and interpret complex data and identify and solve problems by proposing courses of action.
Ability to plan short and long range and to manage and schedule time.
Ability to handle stress in meeting deadlines and dealing with large numbers of employees and/or persons served.

Nice To Haves

utilization management review/oversight experience preferred.

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. Acts on behalf of the person served to assure that necessary clinical services are received and that progress is being made. If denial of service is indicated this position will review pending denial in multidisciplinary Care Conference. If denial or reduction of service is supported in conference, will ensure due process of Adequate or Advanced notice to the persons served.
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. Episodes of care may be selected for sample review or flagged for review due to under or over utilization or due to inadequate documentation in the person-centered plan and supporting assessments. Concurrent review of services includes review of assessment and plan for concurrence with Service Selection guidelines and protocols, consultation with primary care provider and/or persons served and may include written recommendations to the provider and persons served incorporating suggestions for modifications in the plan.
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. If denial or reduction of service is supported in conference, will ensure due process of Adequate or Advanced notice to the persons served.
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. The role through these trainings will be to reduce the incidence of denial or reduction of service decisions.
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.