Lead Applied Behavioral Analysis Analyst / Job Req 604297042

PRINCIPAL RESPONSIBILITIES:

This position will work under the direction of the Behavioral Health Manager to implement processes to ensure effective delivery of the Behavior Health Therapy (BHT) benefit.

The Lead Applied Behavioral Analysis Analyst will achieve quality and productivity standards and ensure compliance with department policies and procedures. The Lead Applied Behavior Analysis Analyst is responsible for the daily operation of Behavioral Health Treatment (BHT) services program, including Applied Behavior Analysis (ABA), under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) program. This includes operational Case and Utilization Management for members who require CDE, BHT and ABA services. This position will ensure that members receive appropriate provider linkage. The position will also oversee the department BCBAs and Behavioral Health Navigators to review assessments and provider-submitted treatment plans.

The Lead ABA Analyst will collaborate with other internal AAH departments to ensure regulatory compliance. The position will interact with delegates contracted organizations and providers, health networks, and other stakeholders in a manner that promotes collaborative working relationships.

Principal responsibilities include:

• Recommend process and performance improvement for the BHT, ABA and CDE services.
• In coordination with Director of QI, support the Plan’s efforts to achieve NCQA accreditation and to maintain all statutory and regulatory requirements on key measures pertaining to BHT/ABA and behavioral health including the review of the policies and practices of delegated entities.
• Work closely with licensed and unlicensed staff to co-manage the care of complex cases telephonically through regular contact with members, caretakers, healthcare professionals and others involved in the member’s care
• Coordinates and consults with the Plan’s contracted subject matter experts: including Licensed neuropsychologists, BCBA’s, neurologists, speech therapists or others as directed by the Manager of Behavioral Health or Senior Director of Behavioral Health to facilitate individual treatment plans and utilization management for members receiving BHT, ABA and CDE services.
• Develops clinical guidelines, policies, and procedures for the provision of BHT, ABA and CDE services.
• Identify, develop, and manage programs and processes to identify and manage high risk members to improve member’s health outcomes.
• Oversee the BHT, ABA and CDE services including Care Coordination, Case Management and Utilization Management.
• Recommends strategies to enhance existing networks performance as identified.
• Oversee BHT, ABA and CDE workload and ensure that timely and effective adjustments are made to ensure timely service to members.
• Collaborates with the other local agencies focused on special needs, mental health and substance use, including Regional Center, Alameda County Behavioral Health (ACBH), and Drug Medi-Cal Organized Delivery System to ensure smooth transitions across the continuum of health care.
• In conjunction with compliance, reviews and analyzes reports and policies provided by delegated vendors and participates in on-site audits as requested.
• Acts as a liaison to community based and governmental providers that serve members.
• Serves as an BHT, ABA and CDE benefit expert for internal departments, health networks, and contracted providers.
• Develop policies and procedures and any necessary case management protocols.
• Assist in writing and implementing business requirements for any software systems that will be used in the assessment, care coordination and case management processes.
• Prepare for and participate in regulatory audits and develop and monitor corrective actions plans related to BHT, ABA and CDE services.
• Reviews activities including progress and barriers towards goals, resolves conflicts or strategizes solutions and adjusts current service plans as needed
• Confers with internal AAH staff as needed to address patterns of utilization and assure that BHT, ABA and CDE services are maintained at an acceptable level of quality.
• Engage internal and external stakeholders in care coordination/case management processes, promote interdisciplinary collaboration, foster teamwork, and champion service excellence in keeping with organizational goals.
• Adheres to administration of BHT, ABA and CDE services including identification and development of clinical practice guidelines and associated trainings.
• Oversee the collection, analysis, and reporting of Care Coordination, BHT, ABA and CDE Referral, Case Management and Utilization Management based on MCG clinical guidelines, state, and federal standards.
• Perform other duties, projects or functions as assigned.
• Anticipate, identify, and analyze care issues and trends, make appropriate recommendations, develop and implement best practice pilot projects aimed at improving quality healthcare outcomes.
• Monitor intake and assessment, care coordination and BCBA Clinician and Navigator productivity.
• Maintains clinical expertise and knowledge of best practices for all relevant clinical areas of BHT/ABA and behavioral health including statutory and regulatory requirements.
• Works to clarify issues regarding a member status, needs, and goals.
• Provides guidance to the BH clinical staff and Navigators on issues related to BHT/ ABA services provided to members.

ESSENTIAL FUNCTIONS OF THE JOB

• Serve as subject matter expert in BHT, ABA and CDE programs in support of the Triple Aim of improving patient experience of care, health outcomes, and reducing overall cost.
• Oversee and perform the primary functions within the BHT, ABA and CDE services including:
• Maintain active unrestrictive registration/license(s) as a BCBA.
• Developing long and short-range strategic plans for BHT, ABA and CDE activities.
• Overseeing daily work of BHT, ABA and CDE Services and leading and participating in internal and external committees and meetings.
• Making oral presentations, as requested.
• Communicating effectively and efficiently internally and externally.
• Complying with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
• Writing, reporting, administration, and analysis.
• Evaluating data analytics pertaining to BHT, ABA and CDE utilization.

• Timely review of outpatient authorization requests within regulatory guidelines
• Serve as a clinical resource to other clinical staff including BCBAs and non-clinical staff, as needed.
• Ability to multi-task and prioritize tasks.
• Perform all job functions with integrity and provide timely internal and external customer service in cooperative, professional, and respectful manner.
• Communicate and coordinate with BHT, ABA and CDE providers, specialists and vendors as appropriate to determine medical necessity of a request.
• Work closely and in collaboration with all staff to maintain open communication among all the clinical departments and create a positive team culture.

PHYSICAL REQUIREMENTS

• Frequent walking and standing.
• Constant and close visual work at desk or computer.
• Frequent lifting of folders, files, binders, and other objects weighing between 0 and 30 lbs.
• Constant sitting and working at desk.
• Extensive typing using keyboard and/or mouse.
• Occasional driving of automobiles.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Doctoral or Master's degree in Social Work, Psychology, Marriage and Family Therapy, Education or other related field is preferred.
• Board Certified Behavioral Analyst (BCBA) or BCBA-D is required.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• 5 years of experience providing BHT/ABA therapy to children diagnosed with ASD is required.
• 5 years of experience working with health care delivery systems and/or in a public agency serving the related population preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Excellent written and verbal communication skills required.
• Ability to use and manipulate reported data to assess department metrics.
• Experience in use of various computer system software including pharmacy programs, as well as Windows, Word, Excel, Outlook, and PowerPoint.
• Familiarity with HMO, IPA, and medical group contracting concepts, principles, and practices.
• Experience with Medi-Cal program, Department of HealthCare Services and Department of Managed HealthCare preferred.
• In depth understanding of BHT, ABA and CDE standards and clinical care best practices.
• Experience managing BHT, ABA and CDE services including the oversite of BCBAs and non-clinical support staff.

SALARY RANGE $136,119.77-$204,179.66 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.