Utilization Review Clinician - ABA

Position Purpose

Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards.

Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria. Analyzes BH member data to improve quality and appropriate utilization of services. Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services. Provides education to members and their families regarding ABA and BH utilization process. Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies.

Performs other duties as assigned. Complies with all policies and standards.

Education/Experience

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience.
• For Enterprise Population Health 2+ years providing ABA services as a BCBA.
• Licenses to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required.
• Master’s degree for behavioral health clinicians required.
• Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required.
• Knowledge of ABA services and BH utilization review process required.
• Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.

License/Certification

• LCSW - License Clinical Social Worker required or
• LMHC - Licensed Mental Health Counselor required or
• LPC - Licensed Professional Counselor required or
• LMFT - Licensed Marital and Family Therapist (LMFT) required or
• LMHP - Licensed Mental Health Professional (LMHP) required or
• Board Certified Behavior Analyst (BCBA) required

Pay Range

$27.02 - $48.55 per hour

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules.

Qualifications

• Full-time or part-time status.
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.