Licensed Clinician, Senior (Board Certified Behavioral Analyst) Position Available In Plymouth, Massachusetts

Job Description:

Your Role The Behavioral Health Utilization Management teamperforms prospective utilization review for our members andcorrectly applies the guidelines for nationally recognized levelsof care. They collaborate directly with the Member, Member’sFamily, and Interdisciplinary Care Team to achieve consensus andpromote positive Member health outcomes through the assessment,planning, implementation, and evaluation of the Member’s Care Plan.

The Licensed Clinician, Senior will report to the Manager,Behavioral Health Utilization Management. In this role you will beworking with both the Utilization and Care Management teams, whoprovide utilization management, telephonic triage and caremanagement assistance to members requesting access to AppliedBehavioral Analysis (ABA) benefit. This role has a primary functionof utilization management for our members seeking Behavioral HealthTreatment (BHT). Your Work In this role, you will: Performprospective utilization reviews and first level determination formembers using BSC evidenced based guidelines, policies and/ornationally recognized clinal criteria Review Functional BehavioralAssessments (FBA) and Board Certified Behavior Analyst (BCBA)Assessments submitted by providers for adherence to BACB “bestpractice” guidelines Gather clinical information and apply theappropriate clinical criteria/guideline, policy, and clinicaljudgment to render coverage determination/recommendation; prepareand present cases to Medical Director (MD) for medical directoroversight and necessity determination Develop and review membercentered documentation and correspondence reflecting determinationsin compliance with regulatory and accreditation standards andidentify potential quality of care issues, service or treatmentdelays and intervenes or as clinically appropriate Act as a liaisonwith caregivers, providers, and the health care community toprovide information to regarding community treatment resources,mental health managed care programs, company policies andprocedures, and medical necessity criteria Support team throughconsistent and successful caseload management and workload toachieve team goals, regulatory timelines, and accreditationstandards Recognize the members right to self-determination as itrelates to the ethical principle of autonomy, including themembers/family’s right to make informed choices that may notpromote the best outcomes, as determined by the healthcare teamYour Knowledge and Experience Master’s degree in psychology or arelated field Possesses an active BCBA certification At least 5years of experience as a BCBA • Expert knowledge of AppliedBehavior Analysis and Autism Spectrum Disorders Considerableknowledge of Managed Care and the different lines of businessDemonstrated ability to deliver training to varied audiences andconduct effective meetings Experience in a managed health careenvironment with regards to BHT services Ability to identifyproblems and works towards problem resolution independently,seeking guidance as needed Ability to represent the health plan ina professional and knowledgeable fashion Ability to express ideasclearly in both written and oral communications Ability to develop,organize, analyze, and implement processes and proceduresProficiency with Microsoft applications including Word, Excel,Outlook, and Teams Effective interpersonal skills