Sr Case Mgr Behavioral Health - ABA (Remote)

The Senior Case Manager provides oversight and monitoring of the day-to-day activities of the Autism Case Management team focused on providing support to Care Navigators, Care Managers and other clinical team members through:

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The Senior Case Manager provides oversight and monitoring of the day-to-day activities of the Autism Case Management team focused on providing support to Care Navigators, Care Managers and other clinical team members through:

·       Development of program content knowledge

·       Ensuring effective member and provider engagement, in order to build trusted relationships to support needs assessment, access to care, facilitation of services

·       Enhancing understanding of ASD diagnostics, treatment and condition needs, evidenced based practices  

·       Comprehensive case management and clinical coordination, including assessment, care planning, and facilitation of care transitions

·       Documentation, ensuring complete documentation according to policy and procedures, in compliance with regulatory and accreditation standards

This role involves acting as team lead and assisting the Manager in guaranteeing program function activities are consistently applied and achieved. The Senior Case Manager mentors Care Navigators and Care Managers, engaging with both members and providers to facilitate services for the care of autism spectrum disorders, reviewing assessment and ABA requests and ensuring coordination with other service providers. This position also collaborates effectively with managers within the physical and behavioral health case management unit to ensure an integrated approach. The Senior Care Manager will also assist in shaping ABA program development, analyze data, identify program opportunities, and provide point of need support and coaching to clinical team members. The position requires flexibility in job duties and schedule to better serve members and achieve business goals.

Additionally, the Senior Case Manager is responsible for maintaining regulatory compliance with federal, state and accreditation regulations.

Key Responsibilities:

·       Serves as leader, coach and resource for staff to support content knowledge and expertise for autism services including Applied Behavioral Analysis (ABA) including policy/procedure, workflow and assistance with the resolution of inquiries regarding care delivery. 

·       Maintains the responsibility of ensuring staff use established standards of practice, including care navigation, utilization and case management policies, medical policies, desk references

·       Monitors call and case activity to ensure staff interactions with members are focused on identifying barriers and achieving member goals.

·       Demonstrates full understanding of core services offered by the Autism Care management department including care navigation, utilization management and case management.  Provides key services and mentors others in providing care navigation and care management services including:

• Provision of information to inbound members and providers callers regarding Autism, ABA, and other mental health and substance use disorder benefits, community resources, care management programs and services, policies and procedures
• Effective assessment of member needs using appropriate screening criteria and identification of requests that require clinical, medical or other triage for appropriate response

o   Coordination with network leads to implement access to care strategies to remove barriers for families and members with ASD

o   Performs and teaches effective coordination approaches with other service providers such as medical, speech, occupational therapy, and IEP services

o   Supports education of members and providers on diagnostic, assessment and authorization process and required documentation to facilitate efficient intake, care management and utilization management services

o   Works with the BCBAs, Medical Director and other team members to shape care planning and provision

·       Reviews initial case requests for autism services and reviews submitted materials, teaches others accordingly

·       Uses advanced clinical knowledge, critical thinking and assessment skills to provide support and direction regarding nonstandard requests and complex cases

·       Maintains an active workload in accordance with Care Manager performance standards working to communicate effectively with all members and providers and other internal and external resources.

·       Utilizes resources such as Healthwise Connect, which provides a comprehensive view of member claims, medication, gaps in care, lab results, etc.

·       Serves as a preceptor for new employees and ensures new employees gain knowledge and competency around established case management processes and standards of care including crisis intervention.

·       Encourages and supports new employees to identify their professional strengths and needs. Facilitates employee development to ensure employees are engaged in their own personal and professional growth and have the knowledge and support to be successful in their positions.

·       Participates in evaluation of policies and procedures and makes recommendations for improvement to service efficiency and quality of care.

Qualifications:

·       Active unrestricted independent clinical mental health license (eg LCSW, LPC, LMFT) and/or BCBA.

Experience, Knowledge, & Skills:

·       Five (5) plus years behavioral health, psychiatric and/or substance abuse health care setting experience. Prior Case Management and previous supervisory experience is highly desirable.

·       3 years’ experience working with children and or adults with Autism, experience providing case management or utilization management to members with Autism Spectrum Disorder

·       Experience interacting with network providers, preferably ABA providers in a professional, respectful manner that facilitates the treatment process.

• Demonstrated knowledge and experience with quality autism care or autism care management programming and processes, behavioral health measures and quality outcomes

·       Knowledge of DSM 5

·       Team player - builds team spirit and inter-departmental rapport, using effective problem solving and motivational strategy.

·       Change agent - promotes new ideas and methods; thinks outside the box, creates, and acts on new opportunities; is flexible and adaptable.

·       Exceptional communication, problem solving, and interpersonal skills.

·       Action oriented with strong ability to set priorities and obtain results.

·       Acts as a resource for department, using focused professionalism and effective interactions.

·       Committed to total quality management and process improvement.

·       Embraces the diversity of our workforce and shows respect for our colleagues internally and externally.

·       Excellent organizational planning and prioritizing skills.

·       Ability to effectively utilize time management.

·       Proficiency utilizing Microsoft Word, Outlook, Excel, SharePoint, and Adobe programs.  Ability to learn new systems as technology advances.