Vacancy expired!
Position Purpose:Complete complex case review for medical appropriateness and medical necessity determination requiring considerable clinical judgement, independent analysis, critical-thinking skills, and detailed knowledge of Applied Behavior Analysis, best practices and autism research.
Oversee of the contract standards. Ensure timeliness, conduct inner observer agreement reviews, perform audits, and conduct mentoring of Autism Clinical Care Analysts.
Responsible for end to end oversight, under the direction of manager, to ensure processes, policies, and data connect fluently and are accurate in all internal and external reporting.
Act as subject matter expert (SME) of the government customer and full scope of TRICARE benefits. Conduct research, respond, and resolve complex issues.
Conduct new hire training, develop and apply policies and procedures. Participate in the development and execution of system design and testing.
Monitor and audit complex system integration to ensure accuracy and fidelity on an on-going basis.
Conduct clinical necessity reviews and other clinical responsibilities as assigned.
The Lead Autism Clinical Care Analyst is responsible for completing complex clinical case review for medical appropriateness and medical necessity determination requiring considerable clinical judgement, independent analysis, and a detailed knowledge of Applied Behavior Analysis, best practices and autism research. The Autism Clinical Care Analyst, Lead is responsible for conducting clinical new hire training, policy and procedure development and execution, participating and executing system design and testing, and being a clinical subject matter expert to conduct research, respond to complex case issues.Education/Experience:Master’s degree in Applied Behavior Analysis, or related field, required. 5-8 years of clinical experience including a minimum of 1 years of experience as an Autism Clinical Care Analyst, or equivalent position, and 5+ years of applied behavioral analysis experience required. Extensive knowledge of applied behavior analysis within specific population and an understanding and/or working knowledge of insurance funding for applied behavior analysis required. Previous supervisory experience required.Clinical background in multiple settings (in-home, school, or center based) with all ages and beneficiaries preferred.License/Certification:Board Certified Behavior Analyst (BCBA)Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.TITLE: Autism Clinical Care Analyst Lead BCBALOCATION: California, CaliforniaREQNUMBER: 1211591COMPANY: Clinical & Care ManagementPOSITION TYPE: Both
