Care Manager - Remote Behavioral Health Treatment and Applied Behavior Analysis Services Expert

Transforming Lives as a Care Manager in a Dynamic Healthcare Organization Join our esteemed healthcare organization as a Care Manager and make a profound impact on the lives of our members. As a Care Manager, you will be at the forefront of overseeing and evaluating Behavioral Health Treatment (BHT), including Applied Behavior Analysis (ABA) services, to ensure that our members receive the highest quality care based on medical necessity. This is a fully remote role, offering you the flexibility to work from anywhere and be part of a team dedicated to excellence in member service and care management. Job Overview In this vital role, you will be responsible for navigating a mission-focused environment that is dedicated to delivering exceptional member service and care management. You will work collaboratively with team members to achieve departmental objectives and support both immediate and long-term goals. Your expertise will be crucial in assessing requests for medical appropriateness, verifying referrals according to established clinical guidelines, and collecting pertinent medical information for review by the Medical Director. Key Responsibilities Collaborate effectively with team members to fulfill departmental objectives and support both immediate and long-term goals, demonstrating integrity and accountability. Assess requests for medical appropriateness and verify referrals according to established clinical guidelines, ensuring that members receive the necessary care. Collect and review medical information for the Medical Director, communicating decisions clearly and accurately documenting all necessary information in the utilization management system. Conduct thorough reviews of submitted documentation for compliance with coding (ICD-10, CPT-4, HCPCS) and coverage guidelines, maintaining adherence to established policies and procedures. Promptly notify providers and members of decisions made, ensuring timely and effective communication and resolving any potential quality concerns. Stay updated on federal, state, and local regulations pertaining to the BHT benefit, identifying potential quality concerns and reporting them as necessary. Participate in additional projects and responsibilities as assigned, demonstrating flexibility and a willingness to adapt to changing priorities. Essential Qualifications and Skills To succeed in this role, you will need to possess a Master's degree in psychology, social work, counseling, or a related field, along with a minimum of four years of experience in providing ABA or mental health services, including clinical review and treatment plan oversight. You must also hold a current, unrestricted California license (LCSW, LPCC, LMFT, RN with BH experience, BCBA, or BCBA-D). In addition to these qualifications, you will need to demonstrate: Strong relationships with colleagues and external partners from diverse backgrounds, built on trust, respect, and effective communication. The ability to work autonomously, exercising sound judgment in decision-making and communicating effectively in both verbal and written formats. Proficiency in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and related applications, with strong organizational, analytical, problem-solving, and project management skills. The capacity to adapt to a flexible work schedule that may include evenings and weekends, prospering in a fast-paced work environment while managing multiple tasks simultaneously. Preferred Qualifications While not essential, the following qualifications are highly desirable: Experience working in a remote or virtual environment, with a proven track record of success in a similar role. Knowledge of healthcare regulations and accreditation standards, with a strong understanding of the BHT benefit and related services. Excellent communication and interpersonal skills, with the ability to inspire and motivate team members and external committees. Career Growth Opportunities and Learning Benefits Our organization is committed to your professional development, offering numerous opportunities for skill enhancement and career advancement within the healthcare sector. As a Care Manager, you will have the chance to collaborate with a dedicated team, enhancing your professional network and skillset in the healthcare community. Work Environment and Company Culture We foster a collaborative environment that emphasizes high-quality performance and member service, nurturing a culture of dignity and respect. As a fully remote role, you will have the flexibility to work from anywhere, while still being part of a team that is dedicated to making a difference in the lives of our members. Compensation, Perks, and Benefits We offer a competitive salary commensurate with experience, along with a comprehensive benefits package that includes: Health, dental, and vision insurance, ensuring that you and your family are protected. A retirement savings plan with company matching contributions, helping you to plan for the future. Generous vacation and paid time off policies, allowing you to recharge and maintain a healthy work-life balance. Join Our Team and Make a Difference If you are a dedicated and compassionate professional looking to make a meaningful impact in the lives of others, we encourage you to apply for this exciting opportunity. As a Care Manager, you will be part of a team that is passionate about delivering exceptional member service and care management. With a competitive salary, comprehensive benefits, and opportunities for career growth and development, this is a role that offers a fulfilling and challenging career path. Apply now and join our team of dedicated professionals who are transforming lives and making a difference in the healthcare community. Apply for this job