Saginaw County Community Mental Health Authority ยท 2 days ago
ABA Care Management Specialist - BCBA
Saginaw, MI
Full-time
Onsite
Mid Level
$72K/yr - $90K/yr
3+ years expSaginaw County Community Mental Health Authority is seeking an ABA Care Management Specialist - BCBA to monitor and coordinate care for individuals receiving applied behavioral analysis treatment. The role involves ensuring the appropriate use of resources, conducting assessments, and providing recommendations for care plans while promoting a culture of recovery and person-centered planning.
Mental Health Care
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
Works closely with and coordinates efforts with those of information systems and administrative staff
May attend meetings; make presentations to groups and/or in-service personnel or contractors
May attend workshops, seminars, or meetings, read journals, periodicals, and research subjects on the Internet to maintain professional proficiency and disseminate information
Must react productively to change and handle other essential tasks as assigned
Qualification
Required
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
Preferred
Utilization management review/oversight experience preferred
Benefits
$6,000 Recruitment Bonus for Clinical Master level new hires!! ($2,000 paid at start, $2,000 paid after 3 months, and $2,000 paid after successful probation period.)
Company
Saginaw County Community Mental Health Authority
Saginaw County Community Mental Health (SCCMHA) is a local, independent, governmental unit serving the greater Saginaw County area, a Community Mental Health Services Program and has been a mental health authority under contract with the Michigan Department of Health and Human Services since October 1, 1997.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase