Role and Responsibilities
The Care Manager, Autism Resources Program staff will provide utilization management and care management for behavioral health and health care navigation for ASD services provided to New Directions eligible members.
- 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.
- Engage family members and conduct 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 utilization review activities for ABA therapy only
- Facilitates health care coordination, communication and collaboration on behalf of the member with providers, health plan care managers, behavior health care managers and community resources.
- Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
- 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.
- 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
This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities as deemed necessary.
marginal (non-essential) functions
- Participates in on-going continuing education as required by professional licensure, certification or as requested by New Directions.
- Participates on special committees or projects for program development as assigned by Manager/Supervisor.
EDUCATION & EXPERIENCE
- 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.
- Previous experience in Case Management, Utilization Management, and/or ABA therapy/BCBA certification is preferred.
- Able to assume a leadership role to facilitate meeting company and unit objectives
- Professional demeanor in response to all situations regardless of the nature or circumstances of the situation
- Able to manage multiple tasks in a fast-paced, changing environment
- must be able to remain in a stationary position
- must be able to move about inside the office
- must be able to communicate and exchange information with others
- must be able to inspect information
- must be able to perform repetitive motion with arms and fingers
- must be able to interpret data
- must be able to problem solve
- must be able to make decisions
- must be able to organize and plan
WORKING CONDITIONS/EQUIPMENT USE
- Work is performed indoors in a typical office environment- not substantially exposed to adverse environmental conditions
- Frequent exposure to VDT screen
- Frequent use of office machines to include telephone, copier, computer and fax machine