Experienced Care Manager – Remote Behavioral Health Treatment and Applied Behavior Analysis Services Specialist

Introduction to arenaflex arenaflex is a dynamic and esteemed healthcare organization dedicated to providing the highest quality of care to its members. As a leader in the healthcare sector, arenaflex is committed to excellence in member service and care management, demonstrating integrity and accountability in all aspects of its operations. With a strong focus on Behavioral Health Treatment (BHT) and Applied Behavior Analysis (ABA) services, arenaflex is seeking a highly skilled and experienced Care Manager to join its team. Job Overview In this vital role, you will have the opportunity to make a significant impact on the lives of arenaflex members, overseeing and evaluating BHT, including ABA services, for eligible members. As a Care Manager, you will ensure that members receive the highest quality of care based on medical necessity, working collaboratively with team members to fulfill departmental objectives and support both immediate and long-term goals. Key Responsibilities Navigate a mission-focused environment dedicated to excellence in member service and care management, demonstrating integrity and accountability. Collaborate effectively with team members to fulfill departmental objectives and support both immediate and long-term goals. Assess requests for medical appropriateness and verify referrals according to established clinical guidelines. Collect pertinent medical information for review by the Medical Director and communicate decisions clearly. Accurately document all necessary information in the utilization management system, ensuring updates on authorizations are recorded. Conduct thorough reviews of submitted documentation for compliance with coding (ICD-10, CPT-4, HCPCS) and coverage guidelines. Maintain adherence to established policies and procedures while conducting quality reviews of documents. Promptly notify providers and members of decisions made, ensuring timely and effective communication. Stay updated on federal, state, and local regulations pertaining to the BHT benefit. Identify potential quality concerns and report them as necessary, assisting with case audits when required. Participate in additional projects and responsibilities as assigned. Essential Qualifications To be successful 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 will also need to hold a current, unrestricted California license (LCSW, LPCC, LMFT, RN with BH experience, BCBA, or BCBA-D). Preferred Qualifications In addition to the essential qualifications, the ideal candidate will possess excellent communication and interpersonal skills, with the ability to establish and nurture strong relationships with colleagues and external partners from diverse backgrounds. You will be able to work autonomously while exercising sound judgment in decision-making, and adapt to a flexible work schedule that may include evenings and weekends. Skills and Competencies To excel in this role, you will need to demonstrate strong organizational, analytical, problem-solving, and project management skills, with the ability to prosper in a fast-paced work environment while managing multiple tasks simultaneously. You will also need to inspire and motivate team members and external committees, and demonstrate proficiency in Microsoft Office Suite (Word, Outlook, Excel, PowerPoint) and related applications. Career Growth Opportunities arenaflex values your professional development and offers 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. Company Culture and Values arenaflex fosters a collaborative environment that emphasizes high-quality performance and member service, nurturing a culture of dignity and respect. Our organization is committed to providing a supportive and inclusive work environment, where all employees can thrive and reach their full potential. Work Environment This is a 100% remote job, offering you the flexibility to work from the comfort of your own home. With a comprehensive benefits package and competitive salary, you will be able to enjoy a healthy work-life balance while making a meaningful contribution to the lives of arenaflex members. Compensation and Benefits arenaflex offers a comprehensive compensation and benefits package, including: Competitive salary commensurate with experience. Comprehensive health, dental, and vision insurance. Retirement savings plan with company matching contributions. Generous vacation and paid time off policies. Conclusion If you are a motivated and experienced healthcare professional looking to make a difference in the lives of others, we encourage you to apply for this exciting opportunity. As a Care Manager at arenaflex, you will be part of a dynamic and esteemed healthcare organization, dedicated to providing the highest quality of care to its members. With a strong focus on career growth and development, and a comprehensive benefits package, this is an opportunity not to be missed. Apply now to join the arenaflex team and start making a meaningful contribution to the healthcare sector. Apply for this job