Care Review Clinician, Applied Behavioral Analysis (ABA)

Experteer Overview In this role you will assess ABA and BHT services to ensure medical necessity, regulatory alignment, and cost-effective, quality member care. You will collaborate with utilization, care management, and provider teams to integrate services for members with ASD and related disorders. You will review assessments, perform peer consults, and support training and guidelines to optimize treatment impact. The position focuses on ensuring timely access and adherence to best practices within a managed care framework.

Compensation / Benefits

• Assess ABA services for outcomes, cost-effectiveness, and regulatory compliance
• Review requests against evidence-based guidelines and determine eligibility/length of stay
• Collaborate with utilization and care management to deliver ABA and BHT
• Approve prior authorizations based on medical necessity and best practice guidelines
• Provide peer-to-peer consultation to in-network BHT providers
• Monitor treatment plans for effectiveness and efficacy
• Support provider contracting, recruitment, and network adequacy
• Coordinate with ABA providers to ensure best service practices
• Develop and coordinate BHT trainings and guidelines
• Coordinate with care management to ensure timely access to BHT
• Collaborate with behavioral health medical directors on BHT benefits
• Travel up to 30% as required by state/contractual needs Tasks
• ≥2 years healthcare experience including work as a behavior analyst or equivalent
• BCBA or LBA certification (active and unrestricted if licensed)
• Knowledge of community resources
• Proactive, detail-oriented, and able to work independently
• Strong communication, time management, and multi-tasking
• Ability to work with diverse populations and settings
• Excellent problem-solving and critical-thinking skills
• Proficiency in Microsoft Office
• Experience in utilization management or health plan/managed care is a plus Key requirements
• competitive benefits and compensation package