Cigna Autism Case Manager Specialist - Plano, Pittsburgh, St. Louis, Baltimore, Eden Praire, MN, Phoenix, AZ in Plano, Texas
The Autism Behavioral Specialty Care Management program was created to connect our customers with a team of care managers who have additional training and specialization with Autism Spectrum Disorder. When an individual or family member contacts Cigna Behavioral Health for assistance related to Autism, they are assigned to an Autism Care Manager who will assist the family by providing ongoing case management, addressing all questions and concerns related to Autism benefits, treatments and community supports. The Autism Team is also responsible for educating customers and health care professionals on the medical necessity review process for Autism Behavioral Intervention Therapies (including Applied Behavioral Analysis) and reviewing any request with the health care professional directly.
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.
• Evaluates appropriate health care services and treatment plans in conjunction with outpatient providers.
• Refer to Health Professionals with Autism expertise.
• Complete Utilization Management for any Autism Behavioral Intervention Therapies (including Applied Behavioral Analysis).
• 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 care management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained.
• Performs care management in a telephonic customer- facing environment which involves utilizing a coaching approach that provides support and resources to the customers.
• Assistance in the identification of member health education needs
• Develop SMART goals with our customers to empower them to lead and maintain a healthy lifestyle
• Assesses readiness to change and implements actions to assist members in moving through stages of change to reach their goals
• 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 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 outpatient coaching 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
• 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, etc.) LBA and LBS certification in states where it is considered an independent license.
• Specialized training or experience working with Autism Spectrum Disorder, ABA, or children and/or adolescents in the area of behavioral health.
• Experience with UM (Utilization Management) is preferred as Care Managers review with providers.
• One 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
US Candidates Only : Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us atSeeYourself@cigna.com.
Primary Location: Plano-Texas
Other Locations: United States-California-Glendale, United States-Arizona-Phoenix, United States-Minnesota-Eden Prairie, United States-Pennsylvania-Pittsburgh, United States-Missouri-St Louis, United States-Maryland-Baltimore
Work Locations: 1640 Dallas Parkway Plano 75093
Job: Med Mgt--Case Management
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Job Posting: Jul 14, 2017, 9:31:01 AM