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Horizon Blue Cross Blue Shield of New Jersey · 18 hours ago

Behavior Analyst

United States

Full-time

Remote

Entry, Mid Level

$70K/yr - $94K/yr

2+ years exp

Horizon Blue Cross Blue Shield of New Jersey empowers its members to achieve their best health and has been a leader in health solutions for over 90 years. The Behavior Analyst position involves performing behavioral health duties, ensuring appropriate levels of care, and planning transitions to the continuum of care.

Health Care

Responsibilities

Knowledge of NJ State Autism Mandate to apply when reviewing for medical necessity

Reviews Applied Behavior Analysis evaluations and progress reports of member assigned to determine appropriate authorization or denial recommendations

Presents cases to Autism Joint Case Rounds with medical directors, Behavioral Health and Physical Health interdisciplinary team

Evaluates the necessity, appropriateness and efficiency of behavioral health medical services and procedures provided

Coordinates and assists in implementation of plans for members

Monitors and coordinates services rendered outside of the network, as well as outside the local area, and coordinates internally for negotiation of fees for such services as appropriate. Coordinates with patient, family, physician, hospital, and other external customers with respect to the appropriateness of care from diagnosis to outcome

Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care

Monitors patient's behavioral health medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness

Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided

Encourages member participation and compliance in the behavioral health case/disease management program efforts

Documents accurately and comprehensively based on the standards of practice and current organization policies

Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care

Understands fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes

Evaluates care by problem solving, analyzing variances, and participating in the quality improvement program to enhance member outcomes

Completes other assigned functions as requested by management

Qualification

Licensed Behavioral AnalystBehavioral health experienceApplied Behavior AnalysisCase management principlesUtilization management principlesAnalytical skillsCompassionJudgmentListening skillsPlanning skillsInterpersonal skillsProblem solvingTeam playerTime managementCommunication skills

Required

High School Diploma/GED required

Bachelor's degree required

Requires a minimum of two (2) years behavioral health clinical experience

Active Licensed Behavioral Analyst (LBA) is required

Requires working knowledge of principles and clinical services for Applied Behavior Analysis

Analytical

Compassion

Interpersonal & Client Relationship Skills

Judgment

Listening

Planning/Priority Setting

Problem Solving

Team Player

Time Management

Written/Oral Communication & Organizational Skills

Preferred

Graduate degree preferred or relevant experience in lieu of degree

Behavioral health experience, preferably in a managed care setting, strongly preferred

Prefers proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; prefers knowledge in the use of intranet and internet applications

Prefers working knowledge of case/care management principles

Prefers working knowledge of principles of utilization management

Prefers basic knowledge of health care contracts and benefit eligibility requirements

Prefers knowledge of hospital structures and payment systems