AMVETS Jobs

PRINCIPAL RESPONSIBILITIES:

This position will work under the direction of the Behavioral Health Manager to implement processes to ensure effective delivery of the Behavior Health Therapy (BHT) benefit.

The Applied Behavioral Analysis Analyst Supervisor will achieve quality and productivity standards and ensure compliance with department policies and procedures. The Applied Behavior Analysis Analyst Supervisor is responsible for the daily operation of Behavioral Health Treatment (BHT) services program, including Applied Behavior Analysis (ABA), under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) program. This includes operational Case and Utilization Management for members who require CDE, BHT and ABA services. This position will ensure that members receive appropriate provider linkage. The position will also oversee the department BCBAs and Behavioral Health Navigators to review assessments and provider-submitted treatment plans.

The ABA Analyst Supervisor will collaborate with other internal AAH departments to ensure regulatory compliance. The position will interact with delegates contracted organizations and providers, health networks, and other stakeholders in a manner that promotes collaborative working relationships.

Principal responsibilities include:

• Oversee daily operations of the BHT, ABA and CDE services including Care Coordination, Case Management and Utilization Management.
• Identify, develop, and manage programs and processes to identify and manage high risk members to improve member's health outcomes.
• Assist in writing and implementing business requirements for any software systems that will be used in the assessment, care coordination and case management processes.
• Oversee the collection, analysis, and reporting of Care Coordination, BHT, ABA and CDE Referral, Case Management and Utilization Management based on MCG clinical guidelines, state, and federal standards
• Recommend process and performance improvement for the BHT, ABA and CDE services.
• Monitor intake and assessment, care coordination and BCBA Clinician and Navigator productivity.
• Engage internal and external stakeholders in care coordination/case management processes, promote interdisciplinary collaboration, foster teamwork, and champion service excellence in keeping with organizational goals.
• Anticipate, identify, and analyze care issues and trends, make appropriate recommendations, develop and implement best practice pilot projects aimed at improving quality healthcare outcomes.
• Prepare for and participate in regulatory audits and develop and monitor corrective actions plans related to BHT, ABA and CDE services.
• Oversee BHT, ABA and CDE workload and ensure that timely and effective adjustments are made to ensure timely service to members.
• Develop policies and procedures and any necessary case management protocols.
• Maintains clinical expertise and knowledge of best practices for all relevant clinical areas of BHT/ABA and behavioral health including statutory and regulatory requirements.
• Work closely with licensed and unlicensed staff to co-manage the care of complex cases telephonically through regular contact with members, caretakers, healthcare professionals and others involved in the member's care
• In coordination with Director of QI, support the Plan's efforts to achieve NCQA accreditation and to maintain all statutory and regulatory requirements on key measures pertaining to BHT/ABA and behavioral health including the review of the policies and practices of delegated entities.
• Works to clarify issues regarding a member status, needs, and goals.
• Reviews activities including progress and barriers towards goals, resolves conflicts or strategizes solutions and adjusts current service plans as needed
• Recommends strategies to enhance existing networks performance as identified.
• Develops clinical guidelines, policies, and procedu es for the provision of BHT, ABA and CDE services.
• Acts as a liaison to community based and governmental providers that serve members.
• Coordinates and consults with the Plan's contracted subject matter experts: including Licensed neuropsychologists, BCBA's, neurologists, speech therapists or others as directed by the Manager of Behavioral Health or Senior Director of Behavioral Health to facilitate individual treatment plans and utilization management for members receiving BHT, ABA and CDE services.
• Adheres to administration of BHT, ABA and CDE services including identification and development of clinical practice guidelines and associated trainings.
• Confers with internal AAH staff as needed to address patterns of utilization and assure that BHT, ABA and CDE services are maintained at an acceptable level of quality.
• In conjunction with compliance, reviews and analyzes reports and policies provided by delegated vendors and participates in on-site audits as requested.
• Provides guidance to the BH clinical staff and Navigators on issues related to BHT/ ABA services provided to members.
• Collaborates with the other local agencies focused on special needs, mental health and substance use, including Regional Center, Alameda County Behavioral Health (ACBH), and Drug Medi-Cal Organized Delivery System to ensure smooth transitions across the continuum of health care.
• Serves as an BHT, ABA and CDE benefit expert for internal departments, health networks, and contracted providers.
• Perform other duties, projects or functions as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Oversee the ABA Team
• Serve as subject matter expert in BHT, ABA and CDE programs in support of the Triple Aim of improving patient experience of care, health outcomes, and reducing overall cost.
• Writing, reporting, administration, and analysis.
• Developing long and short-range strategic plans for BHT, ABA and CDE activities.
• Maintain active unrestrictive registration/license(s) as a BCBA.
• Overseeing daily work of BHT, ABA and CDE Services and leading and participating in internal and external committees and meetings.
• Evaluating data analytics pertaining to BHT, ABA and CDE utilization.
• Communicating effectively and efficiently internally and externally.
• Complying with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
• Making oral presentations, as requested.
• Oversee and perform the primary functions within the BHT, ABA and CDE services including:

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``` - Timely review of outpatient authorization requests within regulatory guidelines - Communicate and coordinate with BHT, ABA and CDE providers, specialists and vendors as appropriate to determine medical necessity of a request. - Serve as a clinical resource to other clinical staff including BCBAs and non-clinical staff, as needed. - Ability to multi-task and prioritize tasks. - Work closely and in collaboration with all staff to maintain open communication among all the clinical departments and create a positive team culture. - Perform all job functions with integrity and provide timely internal and external customer service in a cooperative, professional, and respectful manner.

PHYSICAL REQUIREMENTS

Constant and close visual work at desk or computer.

Constant sitting and working at desk.

Extensive typing using keyboard and/or mouse.

Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

Frequent lifting of folders, files, binders, and othe