Who
We Are
At Lucet, we are industry leaders in behavioral health, dedicated to helping people live healthy, balanced lives. Our mission - and our passion -
is to improve the lives of the members we serve and be the ideal partner for our providers.
Lucet's unique combination of people and technology has proven to optimize access to behavioral health care providers and increase a health plan's ability to connect members to quality care. With the industry's largest network of care navigators and technology powered by more than six million assessments and more than 20 years of data, Lucet is the only solution proven to successfully identify and connect people across the entire acuity spectrum with the right care in less than five days on average, and often as little as one day.
Our members, providers and partners fully entrust us to deliver outstanding quality care through coordinated behavioral health services, employee assistance programs, organizational consulting, student well-being programs and more.
When you join Lucet, you become a valued member of our team, serving more than 15 million people across the U.S. Our employees have a passion for helping others - and it shows. From entry-level employees to senior leaders, we are inspired by our members, putting them first in everything we do. From day one, you'll see firsthand the impact you have on our members, knowing you can make a true difference in their lives.
Job Summary
The Clinician, Behavior Analyst staff will provide utilization management and care management for behavioral health and health care navigation for ASD services provided to Lucet eligible members.
Essential Functions
- Participate in the collaborative process of assessment, planning, facilitation and advocacy for options and services to meet the member's health needs through communication and available resources to promote quality cost-effective outcomes.
- Engage family members and conduct telephonic assessments with the member and/or member's parents/guardian to gather information regarding the member's current treatment and identify any barriers to accessing services.
- Verifies member's benefit and eligibility under state mandates or contract specifications
- Completes utilization review activities for ABA therapy only
- Facilitates health care coordination, communication, and collaboration on behalf of the member with providers, health plan care managers, behavior health care managers and community resources.
- Completes appropriate documentation in clinical systems in compliance with regulatory and accreditation standards.
- Provides follow-up and support calls to members and providers as needed and assigned
- Educate and link member's family with services through community, state, and national resources.
- Coordinates peer review with Lucet Physician consultants on clinical cases that are not meeting the medical necessity criteria.
- Provides education to facilities, providers and member's family about the medical necessity determination process and the denial and appeals processes.
- Educates providers regarding quality of care, service delivery, and documentation of care as defined in the Lucet medical necessity criteria and the provider handbook.
- Coordinates discharge planning.
- Participates in clinical staffing and presents clinical cases to staff and consulting providers upon request of supervisor.
- Complies with all Federal and applicable State laws and Lucet policies regarding privacy, confidentiality and security of health information and other designated information.
- Completes Critical Intervention Plans as needed.
- Maintains client confidentiality.
- Performs within the scope of his/her licensure/certification.
- Requires the ability to work from home with minimal supervision and travel as required.
- Adheres to Lucet Mission Statement, Core Values, Code of Business Conduct and Compliance Program
- Participates in on-going continuing education as required by professional licensure, certification or as requested by Lucet.
- Participates on special committees or projects for program development as assigned by Manager/Supervisor.
Required
Job
Qualifications
- Current BCBA certification and licensure if applicable for state of residence
- Direct experience in working with children with Autism Spectrum Disorder in home and/or clinic setting
- Strong computer skills (Word and Excel) required.
- Ability to comprehend medical policy and criteria to clearly articulate health information.
- Excellent communication and interpersonal skills are essential.
Preferred
- Previous experience in Case Management, Utilization Management, and/or ABA therapy/BCBA certification is preferred.
Key Competencies
- Self-motivating
- Able to assume a leadership role to facilitate meeting company and unit objectives
- Professional demeanor in response to all situations regardless of the nature or circumstances of the situation
- Able to manage multiple tasks in a fast-paced, changing environment
Working
Conditions
- Work is performed indoors in a remote, home setting or typical office environment - not substantially exposed to adverse environmental conditions.
- Frequent exposure to VDT screens, video calling, headphones, and computers.
- Physical demands include constant ability to remain in a stationary position, move about inside an office or remote setting, able to communicate and exchange information with others, able to inspect information, and able to perform repetitive motion with arms and fingers.
- Mental demands include constant ability to interpret data, problem solve, make decisions, and organize and plan.
Salary and Other Compensation:
The starting salary that Lucet reasonably expects to pay for this position ranges from $68,000 - $73,000 annually, depending on circumstances including an applicant's skills, education/degrees, certifications, prior experience, market data, and other relevant factors.
This position is eligible for a bonus in accordance with the terms of Lucet's incentive plan based on both company performance and individual performance.
Benefits: The Company offers the following benefits for this position, subject to applicable eligibility requirements: Medical, Dental, Vision, 401(k) with competitive employer match, company paid life and disability insurance, company paid gym access, tuition reimbursement, parental leave, PTO (vacation, sick and volunteering), Remote Work.
This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.
