Manager Case Mgt Behavioral Health, ABA services - REMOTE (PA/NJ/DE) (Healthcare)
Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together we will achieve our mission to enhance the health and well-being of the people and communities we serve.
Job Summary:
The Manager provides oversight and monitoring of the day-to-day activities of the BH Autism Case Management team. They guarantee effective care navigation, case management and utilization management activities are consistently applied and achieved. The manager is responsible for creating and overseeing the program and services designed to meet the needs of members with Autism Spectrum Disorder, including utilization management for Applied Behavioral Analysis therapy and other related interventions. The manager will focus 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
· effective collaboration with managers within physical health and behavioral health case management unit to ensure an integrated approach
The manager is also accountable to hire and develop top talent into all levels of positions within the ACM unit, strive to meet or exceed unit department goals, ascribe to quality management principles. The position requires flexibility in job duties and schedule to better serve members and achieve business goals.
Key Responsibilities:
§ Lead ACM Department in case management, utilization management, network and compliance functions ensuring operational goals are achieved.
§ Proactively identifies opportunities for improvement to the director including but not limited to, changes to BH/ASD stratification rules, process changes that promote an integrated PH and BH model, engagement with ASD vendors and providers.
§ Supports and maintains methods for case coordination between departments so referrals are coordinated without fragmentation.
§ Provides day to day management, counseling, team building, staff development and support required to build and maintain cohesive and effective Autism Care Management operations. Ensure all Human Resources department policies and procedures are enforced.
§ Serves as resource for staff to answer policy/procedure questions and to assist with the resolution of difficult inquiries regarding care delivery. In addition, maintains the responsibility of ensuring staff use established case/care management standards of practice, working to communicate effectively with all members and other internal and external resources.
§ Monitors call and case activity to ensure staff interactions with members are focused on identifying barriers and achieving member case goals.
§ Ensures that new employees follow appropriate case/care management processes and policies and works to develop appropriate skill levels in all associates. Provides coaching and education to the BH Case Managers of department resources and guidelines to improve critical thinking and decision-making capabilities.
§ Identifies and refers cases in which the plan of care/services are not meeting established criteria, where acuity is high, or where quality concerns have been identified to the Medical Director for further evaluation and determination.
§ Ensures utilization decisions are compliant with state, federal and accreditation regulations.
§ Meets or exceeds regulatory turnaround time and departmental productivity goals when processing referral/authorization requests.
§ Assures compliance with all legislative and accreditation standards including NCQA, Department of Health (DOH), FEP, CMS and Department of Labor
§ 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); dual BCBA highly preferred
Experience, Knowledge, & Skills:
§ Experience in managed care as well as care for Autism Spectrum Disorder, including ABA
§ Five (5) plus years behavioral health, psychiatric and/or substance abuse health care setting experience
§ Three or more years previous supervisory/leadership experience is required.
- Demonstrated knowledge and experience with quality autism care or autism care management programming and processes, behavioral health measures and quality outcomes
§ Experience interacting with network ABA providers in a professional, respectful manner that facilitates the treatment process.
§ Team player - builds team spirit and interdepartmental 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.
§ Embrace the diversity of our workforce and show 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.
Fully Remote:
This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
