Care Review Clinician, Applied Behavioral Analysis (ABA)

Experteer Overview In this role you support ABA and behavioral health therapy services for Molina members, ensuring medical necessity and alignment with guidelines, policies, and regulations. You will collaborate across care management, utilization, and provider networks to enable timely, high-quality care. You'll review requests, approve prior authorizations, and monitor treatment effectiveness to support ASD and related disorders. This position offers impact through integrated care delivery and process improvements that balance quality with cost efficiency.

Compensation / Benefits

• Assess ABA services for outcomes, cost-effectiveness, and regulatory compliance
• Analyze member/provider requests against evidence-based guidelines
• Determine benefits/eligibility and expected length of stay for treatments
• Collaborate with utilization and care management to deliver ABA/BHT services
• Approve prior authorization requests based on medical necessity and best practices
• Participate in interdepartmental integration to enhance BHT care
• Provide peer-to-peer consultation to in-network BHT providers
• Monitor BHT treatment plans for effectiveness and outcomes
• Support provider contracting and relations to ensure network adequacy and timely services
• Collaborate with ABA providers to ensure best service practices
• Develop and coordinate internal and external BHT trainings
• Create guidelines and forms for BHT delivery
• Coordinate with care management for access to BHT services
• Coordinate with behavioral health medical directors for BHT benefit management
• Travel up to 30% as required by state/contractual needs Tasks
• At least 2 years of health care experience with behavioral analyst work or equivalent
• Board Certified Behavior Analyst (BCBA) or Licensed Behavior Analyst (LBA); active, unrestricted license if required by state
• Knowledge of community resources
• Proactive, detail-oriented, able to work independently
• Strong communication and relationship-building skills
• Time-management and multi-project prioritization abilities
• Problem-solving and critical-thinking skills
• Proficiency in Microsoft Office and related software
• Experience in utilization management or health plan/managed care preferred
• Licensed in multiple states preferred Key requirements

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