The WV Traumatic Brain Injury (TBI) Waiver Program, scheduled to begin November 2011, is designed to facilitate community-based treatment of adults with acquired brain injury. The TBI program focuses on early intervention for mental, physical, speech, occupational and social rehabilitation to minimize lasting injury effects and to help bring about maximize functioning. APS Healthcare will be developing a specialized provider network, including helping train providers and assist in obtaining certification. APS Healthcare will perform medical evaluations for program eligibility and reviewing/approving self-directed spending plans (including helping establish care budgets by member), and prior-authorization of services.
The Care Manager’s primary responsibilities include integration of clinical information related to prior authorization requests within established time frames for Medicaid traumatic brain injury services and case discussions with providers regarding clinical recommendations/service utilization. Applicant will assist team members with updating utilization criteria, the development of internal review protocols and establishing individual recommendations for provider technical assistance and training related to best practices. The Care Manager will provide customer service, consultation to providers and contractors, and will have knowledge of traumatic brain injury conditions, best practices and ability to integrate information for medical necessity determination.
•Bachelor’s Degree from accredited facility and an active WV clinical license in Social Work, Psychology, Counseling or RN. TBI certification a plus.
•Social work license must be LSW level or higher if no other clinical license from another discipline present.
•Must be in good standing with licensure board and maintain clinical licensure.
•Minimum of 1-2 years experience with traumatic brain injury; one of the years have been providing direct service.
•Medicaid/Public Sector service experience preferred.
•Utilization Management experience a plus.
•Possess clinical knowledge of TBI conditions affecting population groups.
•Familiarity with computer applications and navigation through multiple screens.
•Familiarity with APS-WV programs.
•Maintain confidentiality standards and HIPAA compliance when evaluating all pertinent issues
•Able to organize and prioritize tasks to meet timeline
•Good interpersonal communication, telephone and negotiation skills
•Ability to identify and fulfill provider training needs
•Ability to work within a team yet maintains an individual caseload
•Ability to utilize Microsoft software and web applications.
•Ability to integrate clinical knowledge, best practices and research to formulate decision regarding medical necessity and service appropriateness.
•Able to updating review protocols, utilization management guidelines and other resource documents according to updated clinical information/literature.
•Ability to integrate information related to other APS –WV programs and performs applicable functions when necessary.