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Humana Care Manager, Telephonic Behavioral Health 2 (BCBA) - Remote, United States in Rogers, Arkansas

Description

The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Responsibilities

The Care Manager, Telephonic Behavioral Health 2 (BCBA) is responsible for the administration and monitoring of the Autism Care Demonstration (ACD) including coordination of services for ABA Therapy, benefits provided under the Exceptional Family Member Plan (EFMP), auditing for quality and clinical compliance, and case management. Serve as a Humana Military/Humana Behavioral Health liaison to TRICARE beneficiaries, guardians, personal care managers and providers.

Role Responsibilities

  • Review and assess necessary record components and requests medical records.

  • Log record requests and monitor for receipt.

  • Interact with providers to ensure proper records are received and discuss any barriers to obtaining appropriate documentation.

  • Complete required audits of clinical records.

  • Assist in entry and review of CDRL data pertaining to the ACD.

  • Review data for accuracy.

  • Assist with analysis of necessary education and improvements in documentation.

  • Review pend queues for referral and authorizations.

  • Coordinate and approve services for ABA Therapy.

  • Review outcome measures to ensure compliance with ACD.

  • Ensure audits are entered for clinical record accuracy.

  • Monitor for quality standards, claims accuracy, fraud, and required clinical elements.

  • Perform telephonic case management with beneficiaries throughout the United States with a focus upon behavior change and coordination of services.

  • Assess the needs of identified beneficiaries and work with providers and Humana Government counterparts to develop an individualized plan of care and provide care coordination assistance to members, guardians and providers.

  • Participate in case management and coordination of services in an effective and efficient manner in accordance with Clinical Department and Program Policy and Procedures.

  • Utilize Motivational Interviewing and Solution-Oriented approaches in communication.

  • Work collaboratively with Humana Government medical case managers to provide consultative assistance and participate in integrated care plans.

  • Close cases efficiently and appropriately as indicated by beneficiary progress.

  • Follow beneficiary to ensure coordination and approval of services.

  • Assess the needs of identified beneficiaries and work with providers and Humana Government counterparts to develop an individualized plan of care and provide care coordination assistance to members, guardians and providers.

  • Close cases efficiently and appropriately as indicated by beneficiary progress.

Required Qualifications

The Care Manager, Telephonic Behavioral Health 2 (BCBA) must meet one (1) of the following requirements:

  • BCBA (Board Certified Behavior Analyst) Certification.

  • A current, valid and unrestricted Licensed Clinical Social Worker (LCSW Licensed Masters Social Worker (LMSW_ACP), Licensed Professional Counselor (LPC), Psychologist (PHD) or other professional license.

The Care Manager, Telephonic Behavioral Health 2 (BCBA) must meet all of the following requirements:

  • Our Department of Defense Contract requires U.S. citizenship for this position.

  • Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing).

  • 1 or more years of applied behavioral analysis (ABA) with ASD (Autism Spectrum Disorder) experience.

  • 1 year managed care experience.

  • An active designation as a Certified Care Manager (CCM). If no active designation as a CCM at hire date, this must be obtained within the first year of hire.

  • Above average written and verbal skills, including organizational abilities.

  • Proficiency in Microsoft Office programs specifically; Word, Excel and Outlook

  • Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required.

  • Must have a separate room with a locked door that can be used as a home office, to ensure you and your patients have absolute and continuous privacy while you work.

  • Extensive analytical skills.

  • Ability to handle high volume of calls and customer contacts in a polite and professional manner.

  • Ability to handle multiple projects simultaneously and to prioritize appropriately.

  • Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test.

Preferred Qualifications

  • Prior experience with the TRICARE Autism Care Demonstration.

  • Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism.

  • Direct or Indirect Military experience a plus.

  • Certified Case Manager (CCM)

  • Bilingual a plus.

Additional Information

The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective July 1, 2011, Humana adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.

Work Days/Hours : Monday - Friday; must be able to work an 8 hour shift between 8:00 am - 7pm EST.

Training/Training Hours: Mandatory for the first 4 - 6 weeks; 8:00am - 4:00pm EST

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

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