Clinical Care Reviewer - Board Certified Behavioral Analyst-2 (Dayton)

Clinical Care Reviewer BCBA

Clinical Care Reviewer BCBA is responsible for determining medical necessity and appropriateness of authorization for behavioral health care services, (i.e. outpatient services, applied behavior analysis (ABA) and care coordination for members enrolled with a CareSource Management Group line of business. Additionally, the BCBA will monitor the delivery of behavioral healthcare services to ensure they are provided in a cost-effective manner.

Essential Functions :

• Complete prospective, concurrent and retrospective review of Behavioral Health services, Applied Behavior Analysis (ABA)
• Review age-appropriate testing, evaluation, and assessment tools submitted to determine the appropriateness of ABA Therapy
• Coordinate and facilitate timely and cost-effective care to the appropriate service level.
• Refer cases to CareSource Medical Directors when clinical criterial are not met or when a case conference is necessary
• Stay informed about state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
• Identify and escalate quality issues to Quality Improvement
• Recognize and refer members appropriate for Case Management
• Document, and communicate with Health Partners, Care Managers and Discharge Planners to establish safe discharge planning needs and care coordination
• Provide support and guidance to non-clinical medical management staff
• Attend medical advisement and State Hearing meetings, as requested
• Assist with special projects or research, as needed
• Perform any other job-related tasks as assigned

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range : $61,500.00 - $98,400.00

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly / salary) : Hourly

Organization Level Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.