Clinical Quality Reviewer - BCBA

Responsibilities

• Review ABA treatment plans and supporting clinical documentation for medical necessity and clinical appropriateness and compare platform-generated outputs, analyses, and recommendations against independent clinical review findings.
• Identify discrepancies, edge cases, or workflow gaps and provide structured feedback to support ongoing platform refinement.
• Collaborate cross-functionally with clinical, product, engineering, and account management teams to help improve the product to ensure stellar customer experience.
• Participate in calibration and inter-rater reliability activities to ensure consistency.
• Aid in the development and refinement of quality assurance and improvement methodologies, audit tools, and outcome metrics.
• Perform other data validation tasks as needed.
• Maintain accurate and timely documentation of findings and recommendations.

Qualifications

• Current BCBA certification in good standing.
• Minimum 2–3 years of experience in ABA utilization management, clinical supervision, quality assurance/improvement (specific to ABA/autism services) or in an equivalent ABA leadership role.
• Experience reviewing ABA treatment plans and assessing clinical justification for recommended services.
• Strong understanding of medical necessity criteria and general payer expectations related to ABA services.
• Experience auditing clinical documentation and charts for quality and compliance.
• Strong written communication and analytical skills.
• Exceptional attention to detail and organizational skills.
• Ability to work independently in a fast-paced environment.

What We're Looking For

• Experience in utilization management, care review, or prior authorization review for a payer or managed care organization (nice to have).
• Experience with quality metrics/outcomes data (nice to have).
• Familiarity with multiple ABA payer guidelines, authorization processes, and documentation standards (nice to have).
• Experience using EHRs and clinical review platforms (nice to have).
• Experience analyzing claims, utilization, or outcomes data (nice to have).