ABA Care Management Specialist - BCBA

SCCMHA JOB VACANCY ANNOUNCEMENT

CLASSIFICATION: ABA Care Management Specialist - BCBA

PAY GRADE: $72,102.15 - $89,883.67 Annually

$10,000 Recruitment Bonus for Clinical Master level new hires!! (First installment paid at start, second installment paid after 3 months, and third installment paid after successful probation period.)

Under supervision of the Director of Utilization Management and Care Authorizations, monitors appropriate uses of Saginaw County Community Mental Health Authority (SCCMHA) resources for applied behavioral health (ABA) treatment and support of individual episodes of care, coordination of care and adequacy of supports and services to sustain outcomes. This position uses best practices derived from scientific evidence to bring together health care resources from across the continuum of care in the most appropriate, effective, and efficient manner to care for the person served.

Specific duties in utilization review may be assigned within individual staff scope of practice and target population expertise. Performs responsibilities and tasks with a demeanor and attitude that promotes goodwill, builds positive relationships, communicates respect for human dignity, and contributes positively to the mission and values of SCCMHA. This position will be knowledgeable about and actively support culturally competent recovery-based practices;

person centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid persons served in the recovery process.

1. Provides preauthorization of services based on review of assessments and the medical record for evidence of medical necessity and within the definition of the benefit. Acts on behalf of the person served to assure that necessary clinical services are received and that progress is being made. If denial of service is indicated this position will review pending denial in multidisciplinary Care Conference.

If denial or reduction of service is supported in conference, will ensure due process of Adequate or Advanced notice to the persons served.

2. Reviews level of functioning assessments including CAFAS, LOCUS, SIS, ASAM, MichiCANS and others as implemented by SCCMHA and decides on appropriate level of care placement for mental health and substance use treatment services.

3. Works in multiple electronic health record systems with the ability to ensure data integrity and accurate data interface between systems.

4. Provides concurrent review of ABA treatment plans/goals/community-based services regarding quality, outcomes, and fidelity criteria; works as a team member with utilization management tasks related to management of the entire behavioral health benefit. Episodes of care may be selected for sample review or flagged for review due to under or over utilization or due to inadequate documentation in the person-centered plan and supporting assessments.

Concurrent review of services includes review of assessment and plan for concurrence with Service Selection guidelines and protocols, consultation with primary care provider and/or persons served and may include written recommendations to the provider and persons served incorporating suggestions for modifications in the plan.

5. Ensure ABA provider network SAL documentation is targeted, sufficient, and timely; ABA targets/goals accurately identify baseline data as well as outcome and new targeting measures as plans change.

6. Through concurrent review, may recommend the denial of authorization or reauthorization of service or may suggest reduction in the quantity or…