UM Manager BCBA

Profile

Description

This is a salaried exempt position with responsibility for utilization management oversight and clinical decision-making as outlined in the Autism Care Demonstration (ACD) defined in the TRICARE Operations Manual Chapter 18, section 4.

Responsibilities

The UM Manager will lead a team of Board Certified Behavior Analysts (BCBAs) conducting clinical necessity reviews in the delivery of care to a specific beneficiary population in accordance with the Autism Care Demonstration (ACD), as it specifically relates to Utilization Management (UM), addressing treatment needs of individuals diagnosed with Autism spectrum disorder (ASD) who frequently receive treatments by providers from several different disciplines--such as ABA services, PT, OT, and SLP--that target the same core symptoms or functional deficits when approving all TPs, ABA service requests and every six-month reauthorizations thereafter. Associate will utilize specified UM tools to assist in guiding clinical decisions. The UM Manager will be responsible for workload management, monitoring of caseloads and distribution of the team. The Manager will provide coverage for all holidays, both standard and non-standard, as well as support contingency operations. The Manager will ensure all referrals are processed to meet timeliness standards, which includes monitoring of individuals, team and work queues within the referral management system called MSR (Medical Services Review). The Manager is responsible for timely decisions and reporting performance to include improvement plans when required. Additionally, must be able to manage multiple direct reports and business relationships for projects, which require flexibility, and adaptability for evolving government regulations.

Humana Government Business government contract requires U.S. citizenship for this position .

KEY ACCOUNTABILITIES

60 % Manage all aspects of day-to-day operations of the ACD UM Team to ensure identified contractual requirements are met. This includes oversight of all ACD authorization activities to include, clinical necessity review, care coordination, ABA queue call management and performance standards; Establish and maintain open communication and collaborative relationships with other managers, HGB associates, providers, MTFs, eMSMs, to resolve beneficiary and/or provider complaints and grievances and/or DHA concerns as necessary; Coordinates and implements contingency operations when needed.

15 % Collaborate with all Humana operations departments to operate and improve processes related to ACD UM effectiveness with the highest degree of attention to beneficiary and provider experience, team performance and monitor the effectiveness. Support the strategies for efficiency and system improvement, including monitoring the implementation of process changes; Provides area oversight and interfaces with quality management and medical management programs ensuring beneficiary coordination of care. Optimize staff productivity surrounding process management. Strategical look for interventions and methods to improve performance.

15 % Assist in the collection, analyzation and updates on a variety of referral, authorization, provider steerage and utilization management data; Analyze operational reports to reduce errors, increase data accuracy and review provider availability; Evaluates and applies performance and outcome results to improve organizational policies and procedures to maximize workflow and efficiency, and to create best value for our beneficiaries and Government partners.

5% Implement operational metrics to ensure attainment of the programs' goals and performance standards. Strategize with all leaders within the ACD team to make recommendations to the DHA or Humana Government Business to improve policy which may relate to better outcomes, improved utilization management, prevention or identification of fraud waste and abuse, and trend data.

5% Other tasks as assigned.

This role description in no way states or implies that the key accountabilities above are the only ones being performed by the individual(s) with this role description. The individual(s) may be called upon and required to follow other instructions or perform other duties and tasks requested by his or her supervisor, consistent with the purpose of the position, department and/or company objectives.

Required Qualifications


Board Certified Behavior Analyst (BCBA) or a Master's degree or Doctoral degree in a related field with a current, valid and unrestricted license
Minimum of five (5) years of managed care experience, including project management experience for large-scale projects
Minimum of three (3) years of clinical understanding of medical management programs such as case management, ECHO and/or the Autism Care Demonstration
Experience with Microsoft Office products for business presentations including; Word, Excel, PowerPoint, Visio and/or Project
Excellent verbal and written communication and PC skills
Ability to handle multiple projects simultaneously and to prioritize appropriately
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)


Work at Home Requirements


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


Preferred Qualifications


Project management experience with large-scale projects
Experience in cost analysis, tracking performance against daily and weekly metrics, and operational experience
Extensive analytical skills
Passion for military service members and their families


Additional Information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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

Company info

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