Behavioral Health Specialist
3 days ago
We are seeking a highly skilled Behavioral Health Specialist to join our Utilization Management team at Capital Blue Cross. As a key member of our team, you will play a critical role in ensuring that our members receive the necessary care and services to meet their unique needs.
Key Responsibilities- Process authorization requests for services for individuals with Autism Spectrum Disorder (ASD), including Applied Behavioral Analysis (ABA) services, through clinical review and application of approved medical necessity criteria.
- Collaborate with UM department staff, including Clinical Support Specialists and Medical Directors, to make final determinations and ensure seamless coordination of care.
- Participate in weekly clinical rounds to discuss complex members and identify opportunities for improvement.
- Identify and refer members with complex needs to the appropriate population health and/or care management program.
- Attend and participate in company and departmental meetings and training sessions as required.
- Three (3) years' experience working as a Board Certified Behavioral Analyst (BCBA).
- Three (3) years' experience working with and/or providing services for individuals with ASD.
- One (1) year UM experience in managed care required.
- Active and unrestricted Board Certified Behavioral Analyst certification, applicable to the state of Pennsylvania.
At Capital Blue Cross, we prioritize the health and wellbeing of our members and the communities we serve. We foster a flexible and supportive work environment that encourages professional growth and development. If you are passionate about making a difference in the lives of others, we encourage you to apply for this exciting opportunity.
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Behavioral Health Support Specialist
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Behavioral Health Support Specialist
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Advanced Practice Provider
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Behavioral Health Therapist | Harrisburg Clinic
4 months ago
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