The Care Manager, Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided under the Exceptional Family Member Plan (EFMP), auditing for quality and clinical compliance, and case management. Serve as a Humana Military/Humana Behavioral Health liaison to TRICARE beneficiaries, guardians, personal care managers and providers.
Role Responsibilities
Review and assess necessary record components and requests medical records.
Log record requests and monitor for receipt.
Interact with providers to ensure proper records are received and discuss any barriers to obtaining appropriate documentation.
Complete required audits of clinical records.
Assist in entry and review of CDRL data pertaining to the ACD.
Review ABA treatment plans for policy compliance.
Assist with analysis of necessary education and improvements in documentation.
Review pend queues for referral and authorizations.
Coordinate and approve services for ABA Therapy.
Review outcome measures to ensure compliance with ACD.
Monitor for quality standards, claims accuracy, fraud, and required clinical elements.
Perform telephonic case management with beneficiaries throughout the United States with a focus upon policy and utilization management
Participate in case management in an effective and efficient manner in accordance with Clinical Department and Program Policy and Procedures.
Utilize Solution-Oriented approaches in communication with providers.
Close cases efficiently and appropriately as indicated by beneficiary progress.
Follow beneficiary to ensure coordination and approval of services.
3 plus years of experience as a Board Certified Behavior Analyst.
3 or more years of applied behavioral analysis (ABA) with ASD (Autism Spectrum Disorder) experience.
Must be able to work an 8-hour shift sometime between the hours of 8:00 am - 6 pm EST, Monday through Friday and the flexibility to work overtime based on business need. (This may involve weekends)
Above average written and verbal skills, including organizational abilities.
Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook
Ability to handle multiple projects simultaneously and to prioritize appropriately.
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy ( see details below under Additional Information ) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.
Our Department of Defense Contract requires U.S. citizenship for this position.
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) .
Work at Home/Remote Requirements
Must ensure designated work area is free from distractions during work hours and virtual meetings
Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required
Preferred Qualifications
Prior experience with the TRICARE Autism Care Demonstration.
Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism.
Knowledge of CPT codes that apply to ABA and/or experience with DMS-5 criteria
Prior experience with outcome measure assessments to include PDDBI, Vineland, SRS and/or PSI-SIPA
Experience with interpreting medical policy
Direct or Indirect Military experience a plus.
Additional Information
The following policy applies ONLY to associates working in the state of Arizona : Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Work Days/Hours : Monday - Friday; must be able to work an 8 hour shift between 8:00 am - 6 pm EST. (Overtime may be required based on business needs)
Training/Training Hours : Mandatory for the first 4 - 6 weeks; 8:00 a.m. - 5:00 p.m. EST
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
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