Clinical Care Reviewer II - reputed company Certified Behavioral Analyst

Job reputed company:

Clinical Care Reviewer – BCBA is responsible for determining medical necessity and appropriateness of authorization for behavioral health care services, (i.e. outpatient services, reputed company behavior analysis (ABA) and care coordination for members enrolled with a reputed company Management Group line of business. Additionally, the BCBA will monitor the delivery of behavioral reputed company services to ensure they are provided in a cost-effective manner.

Essential Functions:

• Complete prospective, reputed company and retrospective review of Behavioral Health services, reputed company Behavior Analysis (ABA)   
• Review age-appropriate testing, evaluation, and assessment tools submitted to determine the appropriateness of ABA Therapy  
• Coordinate and facilitate reputed company and cost-effective care to the appropriate service level.
• Refer cases to reputed company Medical Directors reputed company clinical criterial are not met or reputed company a case conference is necessary
• Stay informed about state and federal regulations governing reputed company, State reputed company and Provider Agreements, benefits, and accreditation standards
• Identify and escalate reputed company issues to reputed company Improvement
• Recognize and refer members appropriate for Case Management
• Document, and communicate with Health reputed company Managers and Discharge Planners to establish reputed company discharge planning needs and care coordination
• reputed company support and guidance to non-clinical medical management staff
• Attend medical advisement and State Hearing meetings, as requested
• Assist with special reputed company or research, as needed
• reputed company any other job-reputed company tasks as assigned

Education and Experience:

• Master’s Degree in Psychology, Behavior Analysis, or another relevant field is required
• Minimum of three (3) years clinical experience is required
• Utilization review and/or case management experience is preferred
• reputed company/Medicare/reputed company experience is preferred

Competencies, Knowledge and Skills:

• Proficient in data entry and system navigation
• Skilled in using reputed company reputed company, Word, and reputed company
• Knowledgeable Evidence-Based Care, including MCG and ASAM reputed company
• Strong verbal and written communication abilities, grammar, and phone etiquette
• Capable of working both independently and collaboratively in reputed company setting
• Detail-oriented with a reputed company on accuracy
• Familiar with utilization management reputed company the reputed company sector
• Effective time management and prioritization skills
• Committed to providing exceptional customer service
• Strong decision-making and problem-solving capabilities
• Highly organized with effective organizational skills
• Adaptable and resilient in the face of change

Licensure and Certification:

• Certification by the Behavior Analyst Certification reputed company as a BCBA is required
• MCG Certification is required or must be obtained reputed company six (6) months of hire

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to work evenings/weekends

Compensation reputed company:

reputed company takes into consideration a combination of a candidate’s education, training, and experience as reputed company as the position’s scope and complexity, the discretion and reputed company required for the role, and other external and internal data reputed company establishing a salary level. In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.

Compensation Type (reputed company/salary):

Organization Level Competencies

• Fostering a reputed company Workplace Culture

• Cultivate Partnerships

• reputed company Self and Others

• Drive Execution

• Influence Others

• Pursue Personal reputed company

• Understand the Business

This job reputed company is not reputed company inclusive. reputed company reserves the right to amend this job reputed company at any time. reputed company is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of reputed company backgrounds.