What are the responsibilities and job description for the Autism Case Management Lead Analyst position at Cigna?
The Autism Behavioral Specialty Case Management program was created to connect our customers and providers with a team of case managers who have additional training and specialization with Autism Spectrum Disorder. The Team performs reviews directly with providers and for inpatient, residential, partial and Intensive Behavioral Intervention (including Applied Behavior Analysis) requests. As a Care Manager at Cigna, you will use your clinical knowledge and skills to evaluate appropriate health care services and treatment plans in conjunction with inpatient and outpatient providers. You will partner with providers and families to identify and implement a holistic approach to treatment outcomes. You will be part of a virtual organization with multiple sites and must function well both independently as well as part of a larger team.
Role Summary
This position is a great opportunity for licensed behavioral health clinicians to use their industry experience in a managed care setting focused on clinical excellence for participant members. The role offers a great salary with an excellent benefits package that starts your first day of employment including a continuing education program with funding and extra leave time.
Major Duties
- Collaborate with Facilities and Providers telephonically to obtain clinical information and ensure quality treatment outcomes utilizing established Medical Necessity Criteria.
- Refer to Health Professionals with Autism expertise.
- Complete Utilization Management for Applied Behavior Analysis and higher levels of care for individuals with primary diagnosis Autism.
- Provide services that will assist the customer/family members in understanding their options based on their benefits.
- Educate the customer/family members about treatment options, including the need for medical interventions (if appropriate).
- Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
- Assistance in the identification of member health education needs
- Perform research for community and educational resources to assist customers in their journey
- Consult with and assist team members in cases where a member’s behavioral health or emotional issues are impacting their ability to set and/or achieve goals
- Educate and refer members/providers on available health resources and CIGNA Medical Management as appropriate to approach customer holistically
- Collaboration with other team members such as medical directors, pharmacist, nurse clinicians, etc.
- Provides suggestions for improvements and enhancements to case management programs based on data/experience
- Able to manage multiple health records and systems to accurately document customer interactions and progress
- Must be able to comply with HIPAA standards and regulations in telephonic conversation and in documenting medical records.
- Flexibility to assist other teams and partners as needed.
- Perform other related duties incidental to the work described herein
Qualifications
- Specialized training or experience working with Autism Spectrum Disorder is preferred.
- Experience with UM (Utilization Management) is preferred as Case Managers review with providers.
- Requires Master's degree mental health discipline and independent licensure to practice in the state of practice (LICSW, LMFT, LCPC, LPC, LPCC, Licensed Psychologist, Psych RN, LBA, LBS etc.)
- Three to five years post-license mental health experience preferred but will also consider a new independently licensed therapist
- Experience with direct member communication (written and verbal), experience in telephonic counseling/coaching preferred
- Working knowledge of motivational strategies, materials development, training and consultation preferred.
- Proven administrative abilities, with strong computer and software application skills.
Excellent interpersonal skills and the ability to work in a team environment - Demonstrated ability to set priorities including, but not limited to time management and organizational skills
- A high energy level and excellent written and oral communication skills are essential.
- Passion for health improvement of members
- Strong research and analytical skills
- Effective negotiation skills
- Ability to manage own caseload and coordinate all assigned cases
