Care Review Clinician, Applied Behavioral Analysis (ABA)

Experteer Overview In this role you support member ABA review processes to ensure medically necessary therapy aligns with guidelines and policies. You collaborate across care management and utilization teams to deliver high-quality, cost-effective autism-related services. You will review assessments and treatment plans, authorize prior authorizations, and help optimize care pathways. The position emphasizes interdepartmental collaboration, training, and provider support within Molina's behavioral health program.

Compensation / Benefits

• Assess ABA services for outcomes, cost-effectiveness, and regulatory compliance
• Analyze member/provider requests against evidence-based guidelines
• Identify benefits, eligibility, and expected length of stay for treatments
• Collaborate with utilization and care management teams to deliver ABA/BHT services
• Approve prior authorization requests by reviewing assessments and treatment plans
• Participate in interdepartmental integration to enhance BHT care
• Provide peer-to-peer consultation to in-network BHT providers
• Monitor BHT treatment plans for effectiveness
• Support provider contracting and relations to ensure network adequacy and timely services
• Develop and coordinate internal/external BHT trainings
• Create guidelines and forms for BHT service delivery
• Collaborate with care management for timely access to BHT
• Coordinate with behavioral health medical directors on BHT benefit management
• 30% local travel may be required Tasks
• At least 2 years health care experience with behavioral analysis or equivalent
• BCBA or LBA certification; active and unrestricted if licensed
• Knowledge of community resources
• Proactive, detail-oriented, able to work in varied settings and with diverse populations
• Ability to work independently and with minimal supervision
• Strong communication, both verbal and written
• Excellent time-management and multitasking abilities
• Proficiency in Microsoft Office and related software

Preferred:

multi-state licensure; utilization management experience; health plan/managed care experience Key requirements •