BCBA Utilization Review

Job Description:

Select Health is a not-for-profit community health plan serving more than 1 million members in the Intermountain west. Select Health’s line of businesses (LOB) includes Medicare, Medicaid, FEHB, Marketplace Qualified Health Plans and fully funded and self-funded Commercial plan.

This position is a hybrid role that combines the expertise of a Licensed and Masters Prepared Behavior Health Specialist with Utilization and Care management. This role is essential in ensuring that members receive high-quality, cost-effective care. The ideal candidate will possess a strong understanding of Applied Behavior Analysis (ABA) principles, as well as a solid foundation in healthcare operations and regulatory compliance. Candidate will apply expertise in Applied Behavior Analysis (ABA) to review medical records and treatment plans for individuals with autism and other behavioral health conditions to ensure that services are medically necessary, appropriate, and cost-effective.

To show our commitment to you and to assist with your transition into our organization, we will also offer a $2500 sign on bonus to those that have 1+ year of experience.

Job Specifics

• Pay Range: $37.46 - $57.80 Exempt
• Benefits Eligible: Yes
• FTE: Full time
• Shift: Monday - Friday 9am - 5:30pm. Rotating weekends and holidays.
• To learn about additional Intermountain benefits: Click here
• BCBA or experience in Autism and working with Autistic Clients.

Hybrid role (Full on site option available as well).

• Upon completion of 4 week orientation. Primary office at home, will have in office responsibilities in Murray, Utah. Selected candidate should plan to work onsite (dates known in advance) at Select Health or visiting Select Health providers no less than once a month and as needed by Line of Business.
• ** We require employee drive and work onsite when experiencing home internet downtime or other barriers to success at home.

Essential Functions

• Utilization and Care Management of members with Autism or other Behavioral Health conditions.
• Provide ongoing training and support to families and caregivers.
• Collect, analyze, and interpret data to evaluate the effectiveness of interventions.
• Stay current with the latest research and best practices in ABA.
• Inform Select Health Autism and Behavioral Health policy and procedure.
• Peer review to evaluate the work of other BCBAs to ensure adherence to ethical standards, best practices, and regulatory requirements.
• Occasional travel to provider locations within Select Health region.

Utilization Review and Care Management:

• Review and Analysis:
  • Review medical records to determine the medical necessity of services.
  • Evaluate the appropriateness of diagnostic assessments, functional behavior assessments, and treatment plans.
• Decision Making:
  • Make timely and informed decisions about the medical necessity and appropriateness of services.
  • Adhere to regulatory requirements, payer guidelines, and ethical standards.
• Collaboration and Care Management:
  • Facilitate Communication, Organize Collaborative Meetings. And Resolve Conflicts with healthcare providers to ensure coordinated member care.
  • Communicate with members, families, and insurance representatives.
  • Conduct comprehensive assessments of members' needs.
  • Develop and implement individualized care plans.
  • Educate and empower members and families.
  • Advocate for members' rights and access to care.
  • Monitor and evaluate the effectiveness of care plans.

Skills

• Clinical Expertise: Deep understanding of ABA principles and practices.
• Data Analysis: Ability to collect, analyze, and interpret data to inform decisions.
• Communication Skills: Effective communication with healthcare providers, members, and families.
• Problem-Solving: Ability to identify and resolve complex issues.
• Organizational Skills: Strong time management and prioritization skills.
• Interpersonal Skills: Ability to build rapport and collaborate with a diverse team.
• Regulatory Knowledge: Understanding of healthcare regulations and guidelines.
• Critical Thinking: Ability to evaluate information and make informed decisions.
• Attention to Detail: Meticulous attention to detail in reviewing medical records and treatment plans.
• Adaptability: Ability to adjust to changing priorities and work demands

Minimum Qualifications

• Master’s degree in Applied Behavior Analysis or Clinical Social Work, or APRN in Psychology
• Current licensure or Certification in Utah
• Candidates will be required to obtain licensure in others states in Select Health region within 90 days of employment.
• Demonstrated experience and expertise working in clinical Behavior Analysis or Autism specific field.
• Minimum 1 year experience in care management/navigation or closely related field including: Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator job role.
• Intermediate computer and hardware set-up, ability to customize computer settings and use multiple monitors and capable of independent troubleshooting internet and applications.
• Strong clinical skills and experience in behavioral health.
• Knowledge of healthcare insurance and utilization review processes.
• Excellent communication and interpersonal skills.
• Strong organizational and time management skills.
• Ability to work independently and as part of a team.1

Preferred Qualifications

• BCBA or experience in Autism and working with Autistic Clients.
• Utilization Review and Care Management experience highly preferred.
• Must have one year of related experience. This position is specifically for Autism, must have Background in BCBA or working with Autistic Clients and Autism Diagnosis.
• Bachelors degree completed is preferred.
• Ability to work independently and be flexible in a rapidly changing environment.
• Demonstrated excellent written and verbal communication skills.
• Experience working successfully working in a remote environment or using Advanced Microsoft Suite, including Teams (chat, whiteboard, task tracking) & Outlook;
• Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.
• Proficiency in electronic health records and care management software.
• Knowledge of regulatory requirements, such as NCQA, CMS, and state-specific regulations.
• Ability to travel as needed.

Physical Requirements:

Physical Requirements

• Ongoing need for employees to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with colleagues and providers require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.
• May be expected to sit or stand in a stationary position for an extended period of time.

Location:

SelectHealth - Murray

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$37.46 - $57.80

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.