Care Manager, Behavioral Health Treatment

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

What You Will Be Doing:

Under the general supervision of the Behavioral Health Treatment (BHT) Manager, the Care Manager, Behavioral Health Treatment, will work closely with BHT Care Coordinators, who provide telephonic triage and care management assistance to members requesting access to Applied Behavioral Analysis (ABA) benefit. This role has a primary function of utilization management and case management for our members seeking Behavioral Health Treatment (BHT).

Supervises

• None

Essential Functions

• Use appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral health treatment (applied behavioral analysis “ABA”) in accordance with Utilization Management Clinical Guidelines and regulatory requirements.
• Refer cases to Peer Reviewers as appropriate.
• Performs applied behavioral analysis assessment, coordination, implementation, case planning, monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.
• Coordinate and complete reviews with Providers and Agencies providing ABA

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required

• Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines.
• Strong interpersonal skills – interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
• Strong written and oral communication skills, with the ability to communicate professionally to diverse individuals inside and outside of HPSJ, effectively explain complex information and document according to standards.
• Strong knowledge of and proficient skills in administering protocols.
• Ability to read, interpret and apply complex written regulations, guidelines and other materials; ability to read and interpret basic clinical information.
• Strong analytical and assessment skills.
• Strong problem-solving skills.
• Produces work that is accurate and complete.
• Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
• Ability to work independently and as part of a team.
• Time management and organizational skills. Uses time effectively and efficiently. values time. Concentrates efforts on the more important priorities. Can attend to a broader range of activities and meet deadlines.
• Strong Microsoft Office suite technical skills and abilities (Word, Excel, PowerPoint, SharePoint, etc.)
• Ability to handle confidential information with appropriate discretion.
• Possesses a BCBA certification.
• At least 5 years of experience as a BCBA.
• Expert knowledge of Applied Behavior Analysis and Autism Spectrum Disorder.
• Considerable knowledge of Managed Care and the different lines of business
• Demonstrated ability to deliver training to varied audiences and conduct effective meetings
• Experience in a managed health care environment with experience in BHT services.
• Ability to identify problems and work towards problem resolution independently, seeking guidance as needed.
• Ability to represent the health plan in a professional and knowledgeable fashion
• Ability to express ideas clearly in both written and oral communications
• Ability to develop, organize, analyze and implement processes and procedures
• Proficiency with Microsoft applications, Word, Excel and Access
• Effective interpersonal skills

What You Have:

Education and Experience

Required

• Current active unrestricted license certification of a Board-Certified Behavioral Analyst (BCBA
• 3 years of previous experience in case management/utilization management with a broad range of experience with ABA/BHT cases
• Excellent communication, presentation and interpersonal skills
• Ability to maintain and expand knowledgeable and be easy to work with
• Consistent modeling of leadership behavior/values in the industry/workplace are essential.

Preferred

• Proficient (as defined by HPSJ’s Cultural and Linguistics Program) in one of HPSJ’s threshold languages.
• Basic knowledge of the principles, practices and regulatory requirements of managed care.
• Knowledge of Medi-Cal or other government sponsored programs and regulations

Licenses, Certifications

Required

• Active and Current Board-Certified Behavioral Analyst (BCBA)

Physical Demands

• Frequent sitting, standing and walking.
• Frequent repetitive motion – keyboarding and writing.
• Frequent talking and listening in person and over the phone.
• Occasional handling of materials up to 10 lbs.
• Close up and distance vision requirements.
• Occasional travel.

What You Will Get:

HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee’s birthday, and 9 paid holidays)
• CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
• Two flexible spending accounts (FSAs)
• Employer-Paid Term Life and AD&D Insurance
• Employer-Paid Disability Insurance
• Employer-Paid Life Assistance Program
• Health Advocacy
• Supplemental medical, legal, identity theft protection
• Access to exclusive discount mall
• Education and training reimbursement in addition to employer-paid elective learning courses.
• A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
• A shorter commute ­– if you’re commuting from the Central Valley to the Bay Area.
• Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.