Care Manager Autism Services Remote-United States

New Directions Behavioral Health - United States2.8

30+ days agoFull-time
The Care Manager I-II, Autism Resources Program staff will provide case management for behavioral health and health care navigation for ASD services provided to New Directions eligible members.
ESSENTIAL FUNCTIONS
  • Participate in the collaborative process of assessment, planning, facilitation and advocacy for options and services to meet the member’s health needs through communication and available resources to promote quality cost-effective outcomes.
  • Conducts telephonic assessments with the member and/or member’s parents/guardian to gather information regarding the member’s current treatment and identify any barriers to accessing services.
  • Verifies member’s benefit and eligibility under state mandates or contract specifications
  • Completes initial and ongoing reviews for ABA therapy only
  • Conducts utilization review activities for all levels of behavioral health care, including inpatient, residential, partial hospitalization intensive outpatient, ABA, and outpatient authorization requests For BCBA’s without an RN or behavioral health master’s level or greater adjunctive license, completes initial and ongoing reviews for ABA therapy only.
  • Facilitates coordination, communication and collaboration on behalf of the member with providers and community resources.
  • Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
  • Identify, evaluate and coordinate behavioral health services for ASD members.
  • Provides follow-up and support calls to members and providers as needed and assigned
  • Educate and link member’s family with services through community, state, and national resources.
  • Coordinates peer review with NDBH Physician consultants on clinical cases that are not meeting the medical necessity criteria.
  • Provides education to facilities, providers and member’s family about the medical necessity determination process and the denial and appeals processes.
  • Educates providers regarding quality of care, service delivery, and documentation of care as defined in the New Directions medical necessity criteria and the provider handbook.
  • Coordinates discharge planning, including ensuring follow up appointments for member’s post discharge from inpatient care within 7 days. Collaborates with provider and member’s family in developing and assisting with member’s transition/aftercare plan.
  • Participates in clinical staffing and presents clinical cases to staff and consulting providers upon request of supervisor.
  • Complies with all Federal and applicable State laws and New Directions Behavioral Health policies regarding privacy, confidentiality and security of health information and other designated information.
  • Completes Critical Intervention Plans as needed.
  • Maintains client confidentiality.
  • Performs within the scope of his/her licensure/certification.
  • Requires the ability to work from home with minimal supervision and travel as required.
  • Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Business Conduct, and Compliance Program.
  • Complies with all Federal and applicable State laws and New Directions Behavioral Health policies regarding privacy, confidentiality and security of health information and other designated information.
EDUCATION & EXPERIENCE REQUIRED
  • Current BCBA certification and licensure if applicable for state of residence
  • Direct experience in working with children with Autism Spectrum Disorder in
home and/or clinic setting
  • Strong computer skills (Word and Excel) required.
  • Ability to comprehend medical policy and criteria to clearly articulate health
information.
  • Excellent communication and interpersonal skills are essential.
PREFERRED
  • Previous experience in Case Management, Utilization Management, and/or ABA
therapy/BCBA certification is preferred.