Manager

• Provides support to Care Managers and other clinical team members through content knowledge, technical and utilization management expertise.
• Researches open questions and unresolved issues for Care Managers who are providing direct utilization management services.
• Mentors new Care Managers and assists with training.
• Authorizes and reviews utilization of autism services, including Applied Behavioral Analysis (ABA).
• Collects and analyzes utilization data.
• Assists with shaping of ABA services and assures coordination with other services providers such as medical, speech, occupational therapy, physical therapy and IEP services provided through the school setting.
• Works with ABA treatment team to shape care planning and provision and assures measurements of the child’s progress are ongoing.
• Assures overall case management with the inclusion of behavioral health services when required.
• Provides point of need support and coaching to Care Managers and other clinical team members in the course of normal operations.
• Builds clinical team members expertise through direct feedback and real-time coaching.
• Is available to provide clinical, procedural or interpretational assistance.
• Mentors and trains Care Managers.
• Serves as a `buddy` to new Care Managers during their first few months on the job by providing daily support and feedback.
• Researches and resolves escalated issues that frontline Care Managers cannot resolve in a timely fashion.
• As necessary, takes escalated calls or fills-in for the Care Manager team during high-peak periods.
• Works with the workforce planning team to perform data collection and analysis of trends to determine problem areas and strategies for better practices for the Care Manager team.
• Maintains an active workload in accordance with Care Manager performance standards.
• Provides frontline UM functions during high volume and peak periods.
• Advocates for the patient to ensure treatment needs are met.
• Interacts with providers in a professional, respectful manner that facilitates the treatment process.
• Performs initial case requests for autism services, behavioral health and ABA.
• Reviews all submitted materials and consultation with treatment team providers.
• Reviews IEP, psych testing and other case evaluation materials.
• Provides information to members and providers regarding mental health and autism benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
• Interacts with the company's Medical and Associate Medical Directors and/or Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.
• Leads or participates in team activities to help build a high-performance team.
• Demonstrates flexibility in areas such as job duties and schedule in order to aid Care Center in better serving its members and to help the company achieve its business and operational goals.
• Assists Care Center efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.

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