Health Services - Spec, Utilization Management

Key Responsibilities

• Reviews ABA treatment requests to determine medical necessity, clinical appropriateness, and benefit coverage.
• Applies behavior analytic principles and clinical expertise to evaluate treatment plans, goals, supervision models, and service intensity.
• Conducts research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within the field.
• Collaborates with medical directors, sales and marketing, contracting, provider and member services to determine appropriate benefit application.
• Makes appropriate referrals and contacts as appropriate.
• Offers assistance to members and providers for alternative settings for care.
• Provides guidance regarding ABA best practices, documentation standards, and authorization requirements.

Required Qualifications

• Education Level: Master’s Degree or higher in Behavior Analysis, Psychology, Education, or a related field
• Licensure/Certification: Board Certified Behavior Analyst (BCBA) - Required; Active state licensure as a Behavior Analyst (if applicable in practicing state) - Required
• Experience: Minimum 3-5 years of clinical ABA experience, including development and supervision of ABA treatment programs

Preferred Qualifications

• Prior experience in utilization management, care management, or payer-side review of ABA services
• Working knowledge of managed care and health delivery systems

Ampcus is an Equal Opportunity Employer