Sr Case Analyst Jobs (NOW HIRING)

Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.

We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.

Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.

Authorizes and reviews utilization of autism services, including Applied Behavioral Analysis (ABA). Collects and analyzes utilization data. Assists with shaping of ABA services and assures coordination with other services providers such as medical, speech, occupational therapy, physical therapy and IEP services provided through the school setting. Works with ABA treatment team to shape care planning and provision and assures measurements of the child's progress are ongoing. Assures overall case management with the inclusion of behavioral health services when required. Coaching and mentoring of less experienced Care Managers is required.

ESSENTIAL FUNCTIONS:

• Performs concurrent reviews with treatment team providing ABA services.
• Performs initial case requests for autism services, behavioral health and ABA. Reviews all submitted materials and consultation with treatment team providers. Reviews IEP, psych testing and other case evaluation materials.
• Provides information to members and providers regarding mental health and autism benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.
• Interacts with the company's Medical and Associate Medical Directors and/or Physician Advisers to discuss clinical and authorization questions and concerns regarding specific cases.
• Participates in quality improvement activities, including data collection, tracking, and analysis.
• Leads or participates in activities as requested that help improve Care Center performance, excellence and culture. Supports team members and participates in team activities to help build a high-performance team. Demonstrates flexibility in areas such as job duties and schedule in order to aid Care Center in better serving its members and to help the company achieve its business and operational goals. Assists Care Center efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Maintains an active work load in accordance with Care Manager Performance Standards. Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Assists network by identifying gaps in the network and quality providers. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.

• State the minimum key skills, knowledge, and abilities required for the job.
• Behavioral Health license/certificate such as LCSW, LPC, LMFT, RN (would need to have psych nursing experience to consider) or BCBA. Knowledge of DSM V or most current diagnostic edition.
• A minimum of six (6) years post degree experience in the provision of ABA services including oversight of paraprofessionals performing ABA services.

All your information will be kept confidential according to EEO guidelines.