Manager, Autism Clinical Care

You could be the one who makes a profound impact on the lives of 28 million members as a clinical professional on our Medical Management/Health Services team at Centene, a diversified national organization offering competitive benefits and innovative workplace flexibility.

This position requires a current, valid, and unrestricted Board Certified Behavior Analyst Certification, preferably in the state of Louisiana.

Position Purpose:

The Manager Comprehensive Autism Care provides clinical oversight of the Comprehensive Autism Care program, including processing authorizations, care coordination, and audits for behavioral services provided by Board Certified Behavior Analysts (BCBA), BCBA-D (Doctoral), BCaBA (Assistants) or Behavioral Technician. The Manager supervises nurse(s) responsible for facilitating authorizations and care coordination, BCBA(s) responsible for conducting review of functional behavioral analysis, assessments, and reassessments, initial and updated behavioral plans submitted by treating providers, and administrative staff responsible for clerical support.

• Effectively manages the activities of the Comprehensive Autism Care Team, providing leadership and guidance; interviews, hires, evaluates performance, motivates, trains, and manages performance.
• Identifies department goals and objectives, develops, and communicates action plans through regular staff meetings and other communications, using a team approach to problem solving and setting clear expectations.
• Directs the effective coordination of health care services to achieve program goals and objectives.
• Ensures that Comprehensive Autism Care program services are in compliance with established standards by implementing applicable policies and procedures.
• Works closely with the provider relations department to identify contractual needs in specific areas.
• Acts as a peer reviewer when there is a question about appropriateness of services requested and performed.
• Manages the operations of the Comprehensive Autism Care team to ensure best value health care services are delivered in a manner that satisfies beneficiaries.
• Facilitates complex clinical and financial decision making by presenting thoroughly analyzed cases requiring higher administrative approval or intervention.
• Works with staff in claims and billing departments to resolve complex claims and follows to resolution.
• Negotiates with providers in securing coverage for services medically necessary and financially sound.
• Establishes an integrated continuous quality improvement process to assure high-quality care, customer satisfaction, and contribution to financial performance; incorporates new work processes and approaches to improve efficiency and quality services.
• Provides guidance to Comprehensive Autism Care staff in resolving problematic situations with beneficiaries and families, physicians, and external entities. Investigates and responds to client and provider complaints regarding quality of care. Assumes responsibility for more complex cases requiring administrative intervention.
• Meets and collaborates with the DHA/MTF liaison regarding specific cases and troubleshoots high-profile cases.
• Assists staff as needed on difficult cases, provides educational opportunities with new and difficult cases.
• Provides an advanced level of benefit and clinical analysis according to TRICARE coverage and medical review guidelines.
• Obtains appropriate information for authorization request entry; accurately documents all activities as per policy, including entry into automated systems; interacts with providers or members as appropriate to communicate approval outcomes in compliance with state, federal, and accreditation requirements.
• Participates in department evaluation, audit, and compliance activities; participates on committees and prepares reports, data, and materials for presentations.
• Manages cases to ensure that the beneficiaries' clinical needs are met at the most cost-effective and clinically appropriate level.
• Other duties as assigned.

Education/Experience:

Master's Degree minimum or PhD plus 2 years related postgraduate experience in a related field. Minimum four years' management experience. Three to five years' experience with behavior analysis, training, and experience in Applied Behavioral Analysis applications - Early Childhood, Autism, and/or special needs experience. Leadership experience in a managed healthcare setting preferred.

License/Certification:

Current, valid, and unrestricted Board Certified Behavior Analyst. Requires US citizenship and current security clearance.

Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer committed to diversity and values the ways 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act