Care Manager (BHI-ABA)
Company: Cogent Infotech
Posted on: February 12, 2024
Title: Care Manager (BHI-ABA)
Location; Orange CA
Duration: 6 months
The Care Manager is responsible for the oversight and review of
Applied Behavior Analysis (ABA) services offered to eligible
Client's Health members. The incumbent will screen, triage and
assess members to determine the appropriate level of care based on
medical necessity criteria. The incumbent will review and process
requests for authorization of ABA services from behavioral health
providers. The incumbent is responsible for utilization management,
quality reviews and monitoring activities of ABA services. The
incumbent will directly interact with providers.
- Participates in a mission driven culture of high-quality
performance, with a member focus on customer service, consistency,
dignity and accountability.
- Assists the team in carrying out department responsibilities
and collaborates with others to support short- and long-term
goals/priorities for the department.
- Reviews and processes requests for authorization of ABA
- Performs quality review of submitted documents and ensures the
required elements are met by the established protocols, policies
- Ensures providers complete accurate evaluations, authorizations
and determinations for ABA assessment and services based on
established medical necessity criteria.
- Reviews ABA services requests for medical appropriateness by
using established clinical protocols to determine the medical
necessity of the request.
- Codes each diagnosis of service and procedures according to
established policy and procedure.
- Responsible for mailing rendered decision notifications to the
provider and member, as applicable.
- Documents into the electronic medical records system according
to Client's Health's guidelines and protocols.
- Responsible for adhering to utilization management regulations
and processing timeframes.
- Meets productivity and quality of work standards on an ongoing
- Identifies potential quality issues and fraud/waste/abuse.
- Enters and completes data tracking efficiently and
- Stays current on CPT-4 and Health Common procedure Coding
System (HCPCS) codes related to ABA services and continually
updates knowledge base regarding the codes.
- Stays up to date with federal, state and local regulations that
pertain to the ABA benefit.
- Completes other projects and duties as assigned.
Possesses the Ability To :
- Work in a team environment, be flexible and adapt to
- Manage multiple deadlines in a fast-paced environment.
- Work collaboratively with a wide variety of stakeholders.
- Prepare concise and clear reports.
- Work with all levels of staff to identify and problem-solve
contracted provider issues.
- Work independently with minimal supervision or guidance.
- Establish and maintain effective working relationships with
Client's Health's leadership and staff.
- Communicate clearly and concisely, both orally and in
- Utilize computer and appropriate software (e.g., Microsoft
Office: Excel, Outlook, PowerPoint, Word) and job-specific
applications/systems to produce correspondence, charts,
spreadsheets and/or other information applicable to the position
Experience & Education:
- Master's degree in psychology, counseling or related field
- Board Certified Behavioral Analyst (BCBA) or Board-Certified
Behavior Analyst - Doctoral (BCBA-D) required.
- 4 years of experience providing ABA therapy required.
- 3 years of experience in clinical review and treatment plan
oversight as a credentialed BCBA required.
- An equivalent combination of education and experience
sufficient to successfully perform the essential duties of the
position such as those listed above is also qualifying.
Preferred Qualifications :
- Prior authorization/utilization review experience.
- Utilization management experience in a managed care
- Quality assurance experience.
Knowledge of :
- Prior authorization review and processes.
- CPT/HCPCS coding for ABA services.
- ICD-10 coding and DSM-5 diagnostic criteria for Autism-spectrum
disorder (ASD) and other diagnoses as applicable.
- Culture and needs of the socially and ethnically diverse
population Client's Health serves.
- Principles and practices of health care, health care systems
and managed care.
- Medi-Cal benefits and regulations.
- Community-based organizations, agencies and community
Keywords: Cogent Infotech, Orange , Care Manager (BHI-ABA), Executive , Orange, California
Didn't find what you're looking for? Search again!