(Contract Worker) Licensed Behavior Analyst

Driscoll Children's Hospital•Corpus Christi, TX

About The Position

The Driscoll Health Plan (DHP) Licensed Behavioral Analyst (LBA) is responsible for utilization review of autism service requests for DHP members. This is a contract worker position with a potential to become a full-time employee. The role involves performing utilization review functions, communicating with providers, and collaborating on program development for clinical autism services.

Requirements

Possess a current and unrestricted Texas Licensed Behavioral Analysis license.
Possess a BCBA license.
Maintains utmost level of confidentiality at all times.
Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well as URAC.
Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

Nice To Haves

Knowledge in Texas Medicaid criteria/guidelines preferred.
Knowledge about managed care contracts/guidelines preferred.
Knowledge of programs and services required to support the needs of children with autism preferred.
Knowledge of various reimbursement mechanisms, including third party requirements preferred.
Knowledge of various utilization criteria sets preferred.
Microsoft Office skills preferred.
Demonstrated knowledge of managed care principals is highly desirable.

Responsibilities

Performs LBA utilization review functions recognizing established protocols, clinical pathways, program benefits, and evidence-based medicine tools to determine the appropriate level of care for members.
Communicates with peers and other providers of care to ensure appropriate services are rendered.
Participates in establishing, reviewing, and updating evidence-based standards of autism services.
Collaborates with the Population Health Behavioral Health team in program development, implementation, and management of clinical autism services.
Functions in an advisory role to DHP Medical Directors and Clinical Committees regarding quality patient care services, establishment of patient care and professional staff policies and procedures, and long-range planning of services/programs, with an emphasis on STAR Kids members.
Provides advice on and evaluates the appropriateness of autism services available through DHP.
Reviews and provides advice concerning issues of treatment team performance and evaluation of autism providers.
Provides input on policies, procedures, and quality management matters related to the scope of care normally rendered by an LBA professional.
Participates with DHP Medical Directors and clinical committees in quality management programs and procedures to assure consistency and quality of services.
Acts as a liaison between DHP Administration and the autism network regarding existing and potential services and other professional medical/patient care matters.