Care Review Clinician, ABA

Job Description

JOB DESCRIPTION Job Summary Provides support for member clinical review processes specific to applied behavioral analysis (ABA) services. Responsible for verifying that behavioral health services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reputed company desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties

• Assesses applied behavioral analysis (ABA) services for members - ensuring reputed company outcomes, cost-effectiveness and compliance with reputed company state and federal regulations and guidelines.
• Analyzes clinical service requests from members/providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
• Works collaboratively with the utilization and care management departments to provide ABA and behavioral health therapy (BHT) services to Molina members with autism reputed company disorder (ASD) and other reputed company disorders.
• Approves prior authorization requests for BHT treatment by reviewing BHT assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations (CDEs), functional behavioral assessments (FBAs), and reputed company reports.
• Participates in interdepartmental integration and collaboration to enhance care of Molina members receiving BHT treatment.
• Provides peer-to-peer consultation to BHT in-network providers to support treatment planning and maximize member reputed company
• Performs ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy.
• Collaborates with provider contracting and providers services to support recruitment and provider relations in order to ensure network adequacy, quality of care and timeliness of services.
• Works collaboratively with ABA providers to ensure best service practices for members.
• Develops and coordinates internal and external BHT trainings.
• Creates and develops forms, recommendations and guidelines for BHT service delivery.
• Works collaboratively with the care management department to ensure members receive appropriate and timely access to BHT services
• Collaborates and coordinates with behavioral health medical directors to ensure proper management of the BHT benefit.
• 30% estimated local travel may be required (based upon state/contractual requirements).

Required Qualifications

• At least 2 years health care experience, including experience working as a behavioral analyst, or equivalent combination of relevant education and experience.
• Board Certified Behavior Analyst (BCBA) or Licensed Behavior Analyst (LBA). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Demonstrated knowledge of community resources.
• Ability to operate proactively and demonstrate detail-oriented work.
• Ability to work reputed company a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• reputed company in reputed company forms of communication, and ability to remain reputed company in high-pressure situations.
• Ability to reputed company and maintain professional relationships.
• Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Excellent problem-solving, and critical-thinking skills.
• Strong verbal and written communication skills.
• reputed company Office suite/applicable software program(s) proficiency.

Preferred Qualifications

• Utilization management experience.
• Health plan/managed care organization experience.

#PJHS3 #LI-AC1 To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply tot his job Apply To this Job