Autism Program Specialist II ALD (1 year term with full benefits)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan, serving more than 2 million members. Our mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
About the role
The Behavioral Health Treatment Program Specialist II is responsible for conducting clinical reviews of comprehensive diagnostic evaluations, Behavioral Health Treatment (BHT) plans, and related medical records. The Clinical reviewer determines medical necessity, evaluates requested service intensity against clinical severity and documented progress, and ensures appropriate documentation. The reviewer will confirm compliance with the established clinical policy and state/federal regulatory standards governing Medi-Cal Behavioral Health Treatment (BHT) services. These services apply to individuals with Autism Spectrum Disorder (ASD) and related conditions where individuals require Applied Behavioral Analysis (ABA) or other related BHT services. The Behavioral Health Treatment Program Specialist applies clinical benchmarks and medical necessity criteria consistently and conducts peer-to-peer clinical discussions with providers as needed to coordinate care.
Responsibilities
- Conduct clinical review of comprehensive diagnostic evaluations and BHT treatment plans to determine medical necessity, clinical appropriateness, and accuracy of documentation.
- Review and approve BHT/ABA treatment plans, ensuring requested services are clinically justified, properly documented, and consistent with diagnostic findings and treatment goals.
- Apply BCBA-level clinical judgment to evaluate ABA service requests, treatment hours, goals, and progress notes for medical necessity and clinical soundness.
- Ensure clinical determinations comply with applicable state and federal regulatory standards governing BHT/ABA referral, authorization, and documentation requirements.
- Identify documentation gaps or clinical concerns in submitted records and communicate findings to providers and internal UM/claims staff.
- Perform other duties as assigned.
Requirements
- Master's Degree in Psychology or Applied Behavior Analysis or Related Field.
- At least 2 years of experience as a BCBA with ABA services, assessments, treatment, programming, and familiarity with regulations.
- Experience in face-to-face ABA case management in the field.
- Board Certified Behavioral Analyst - Active, current, and unrestricted California license.
Preferred Qualifications
- Bachelor's Degree.
- Any of the following Licenses/Certifications:
- Licensed Pharmacy Doctorate/Psychology Doctorate - Active, current, and unrestricted California License.
- Licensed Clinical Social Worker (LCSW) - Active, current, and unrestricted California License.
- Licensed Marriage and Family Therapy (LMFT) - Active, current, and unrestricted California License.
Skills
- Understand the Early Periodic Screening Detection & Treatment (EPSDT) process and the eligibility criteria.
- Proficient in reviewing progress reports and assessing appropriateness of clinical treatment and recommendations.
- Excellent verbal, written communication, and presentation skills.
- Proficient in Microsoft Office and computer skills.
Pay
Salary Range: $77,265.00 (Min.) - $100,444.00 (Mid.) - $123,625.00 (Max.)
Schedule
This position is a limited duration position. The term of this position is a minimum of one year and a maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.
Benefits
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental, and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Physical Requirements
Light