Job Description
Job Description
Alliant Health Group, doing business as Alliant Health Solutions ("the Company"), is a family of companies that provides business and professional services supporting the effective administration of healthcare programs and funding to support healthcare improvement initiatives. The Company has been named a "Best Place to Work" for 2022, 2023, and 2024 as well as being named "Healthiest Employer".
Currently, Alliant seeks a Behavior Analyst. This position is part of a multi-disciplinary team and is responsible for the review of services in applied behavior analysis, function analyses and assessment, behavior acquisition and reduction procedures, and adaptive life skills. The Behavior Analyst conducts prior authorization reviews for Georgia Fee-For-Service Medicaid members and out-of-state service requests, while meeting and exceeding contract expectations. In addition, the Behavior Analyst provides consultative services that support Alliant Health Group business and program development initiatives.
In the position, selected candidate will:
- Ensures required review documentation is complete and current; and maintains an organized and complete electronic record on each applicant.
- Accurately and efficiently performs assessment and treatment reviews for applicants related to autism services.
- Accurately renders appropriate decisions based on the information received using the Department of Community Health (DCH) Policy Manual; and clearly and concisely documents the rationale for all nurse reviewer decisions in accordance within the applicable time frame requirements of the contract.
- Performs accurate data entry of clinical review and decision information into Prior Authorization system; appropriately refer cases to Peer Consultants per policy and guidelines.
- Prepares determination letters to applicants using appropriate business format.
- Responds to provider inquiries through “Contact Us” mechanism within established time frames.
- Conducts re-evaluations and review of appeals utilizing stated criteria as outlined in the DCH Policy Manual; completes summary information required for appeals and fair hearings in a timely manner and attend/participates in hearings when required.
- Assist with the development of provider training materials and participates in provider education as required.
- Collaborates with other team members as the Applied Behavior Analysis (ABA) Subject Matter Expert (SME) across multiple Alliant Health Group contracts.
- Coordinates approval requests for out-of-state treatment of behavioral disorders, including autism, neurobehavioral, and mental health diagnoses, and completes reviews within deadlines.
- Coordinate and track out-of-state treatment requests for initial and ongoing treatment.
- Liaise with providers and DCH, educate providers on review processes, and monitor treatment and discharge plans.
- Identifies and documents suspected cases of fraud and abuse to Behavioral Health Services Supervisor, for further referral to Director, Utilization Review Services.
- Performs other tasks and duties as assigned.
Knowledge, skills, abilities, education, experience and training required for the role include:
- Demonstrate ability to perform work with considerable independence by using creative thinking, thorough analysis of problems, and use of innovative approaches to problem resolution
- Advance theoretical clinical knowledge base and problem-solving skills
- Ability to manage time and organize and prioritize work
- Computer literate with Intermediate-level knowledge of Microsoft Office including Word and Excel, and keyboarding at 30-50 WPM and data entry skills required
- Knowledge, skill and ability to work with team and collaborate with others, including interpersonal skills
- Knowledge, skill and ability to communicate verbally, including telephone skills, and written form
- Skill and ability to work with challenging customers
- Ability to travel by car or plane to Company locations, customer meetings or other locations as needed.
Required:
- Master’s degree
- Current Board-Certified Behavior Analyst Certification (BCBA)
- 3 to 5 years’ experience in the field of intellectual disabilities or related disabilities
Preferred:
- Healthcare, government and/or nonprofit experience
- Case Management is a plus
- Medicaid knowledge is a plus
Our culture is caring and supportive with work/life balance and great benefits!
Interested candidates should click the "apply" icon.
Alliant wishes you lots of success in the process!
EOE