Job Description:

• Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to ABA.
• Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
• Coordinates with providers and other parties to facilitate optimal care/treatment.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Requirements:

• Licensed independent behavioral health clinician with KY licensure (LCSW, LPCC, LMFT, LPAT, LP, LBA) or a Registered Nurse (RN) with a KY or compact license with psychiatric specialty or behavioral health experience
• 3+ years clinical practice experience, e.g., hospital setting, direct clinical practice experience required
• Autism treatment/ABA experience required
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding

Benefits:

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• comprehensive benefits package