Thank you for your interest in joining our team! Please review the job information below.
*This is a contract worker position* Potential contract worker to FTE opportunity.
$85 an hour
40 Hour week
General Purpose of Job:
The Driscoll Health Plan (DHP) Licensed Behavioral Analyst (LBA) is responsible for utilization review of autism service requests for DHP members. To this end, the DHP LBA:
1. Performs the LBA utilization review functions recognizing established protocols, clinical pathways, program benefits as well as currently available evidence-based medicine tools to arrive at an appropriate level of care for all members.
2. Communicates with peers and other providers of care to ensure appropriate services are rendered.
3. Participates in establishing, reviewing and updating evidence-based standards of autism services.
4. and collaborates with Population Health Behavioral Health team in program development, implementation and management of clinical autism services.
Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by Health Plan leadership, as required.
Knowledge, Skills and Abilities:
1. Knowledge in Texas Medicaid criteria/guidelines preferred.
2. Knowledge about managed care contracts/guidelines preferred.
3. Knowledge of programs and services required to support the needs of children with autism preferred.
4. Knowledge of various reimbursement mechanisms, including third party requirements preferred.
5. Knowledge of various utilization criteria sets preferred.
6. Microsoft Office skills preferred.
7. Maintains utmost level of confidentiality at all times.
8. Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
9. Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
10. Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
Responsibilities:
1. Function in an advisory role to all DHP Medical Directors and Clinical Committees in the following areas:
a. Providing evaluation of and assistance with development of quality patient care services offered by DHP.
b. Assisting in the establishment of patient care and professional staff policies and procedures of DHP; and
c. Participating in long-range planning of services and/or programs offered by DHP, again with an emphasis on, but not exclusively to, STAR Kids members.
2. The DHP LBA shall:
a. Provide advice on and evaluate of the appropriateness of autism services available through DHP.
b. Review and provide advice concerning issues of treatment team performance and evaluation of autism providers.
c. Provide input on policies, procedures and quality management matters when these pertain to the scope of care normally rendered by a LBA professional.
d. Participate with the DHP Medical Directors and clinical committees in quality management programs and procedures established by DHP to assure the consistency and quality of all services provided by DHP.
e. Act as liaison between DHP Administration and the autism network regarding the existing and potential services offered by DHP and other matters that may arise of a professional medical/patient care nature.
Education and/or Experience:
Bachelor’s or master's degree in psychology or education.
Possess a current and unrestricted Texas Licensed Behavioral Analysis license as well as a BCBA license.
Demonstrated knowledge of managed care principals is highly desirable.