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Clinic Operations Strategy Professional 2- BCaBA

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Job Details
Job Order Number
Company Name
Physical Address

Dover, DE 19904
Job Description


The Clinic Operations Strategy Professional 2 creates and implements processes and programs to ensure the staff and facilities in emerging markets are fully prepared for successful operations. The Clinic Operations Strategy Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.


The Clinic Operations Strategy Professional 2 (BCaBA) will oversee the quality and clinical outcomes of the Autism Care Demonstration (ACD) defined in the TRICARE Operations Manual Chapter 18, section 4; consult and collaborate with the Humana Military clinical team managing covered services for TRICARE beneficiaries under the ACD and those who qualify for the Extended Care Health Option (ECHO) program.

Role Responsibilities

+ Oversight of TRICARE utilization management and quality evaluations for ASD cases under the guidelines set forth in the TOM Chapter 18, section 4. This includes case assessments for second level review recommendations, record audits for quality oversight, ensuring outcomes are appropriately documented in the treatment record and evaluating for efficacy and progress; participation in quality monitoring and oversight as required under the ACD

+ Serve ABA subject matter expert (SME) engaging with DHA, network and non-network providers; as consultant for medical directors and clinical team as appropriate in evaluating medical necessity determinations ensuring program effectiveness under the rules and regulations of the ACD.

+ Serve as the ACD Complaint Officer responsible for issue resolution, monitoring, tracking and trending of escalated issues received from beneficiaries, family members and caregivers related to services under the ACD.

+ Develop, maintain and assure compliance with policies and procedures.

+ Contribute to creation of required annual behavioral health focused articles, newsletters and CoE updates/maintenance; participate in provider and beneficiary education, providing beneficiary and provider educational content and collaborating with team members across the enterprise as appropriate.

+ Support collaborative relationships with providers and other stakeholders throughout the East Region; contribute to quarterly updates to DHA on the CoE enhancement.

Our Department of Defense Contract requires U.S. citizenship for this position

Required Qualifications

+ Must have current unrestricted state issued license or certification as an Assistant Behavioral Analyst (BCaBA)

+ 5 years of professional experience in the field of ABA

+ Experience with Electronic medical records/EMR and/or Health Information Management/HIM systems

+ Knowledge of and experience working with Provider’s in the Communities

+ Knowledge of Excel, Word and Power Point Presentations in a business setting

+ A high level of engagement and emotional intelligence

+ Proven interpersonal skills with the ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA’s, community organizations and other health plan staff

+ Our Department of Defense Contract requires U.S. citizenship for this position

+ Successfully receive interim approval for government security clearance (eQIP – Electronic Questionnaire for Investigation Processing)

Preferred Qualifications

+ Strong understanding of Policies and Procedures

+ Previous TRICARE/Military/Government experience

Additional Information

Interview Format

+ As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice, Video and/or Text to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

+ If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage. In this interview, you may listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours


About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

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