Board Certified Behavior Analyst

Utilization Management Specialist – Behavioral Health (BCBA)

Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

Role:
Utilization Management Specialist – Behavioral Health (BCBA)

Location:

100% Remote

Duration: 6-Month Contract-to-Hire

Position Overview:

We are seeking a highly skilled and experienced Utilization Management Specialist – Behavioral Health to join our team. The ideal candidate will be a Board Certified Behavior Analyst (BCBA) with experience providing Applied Behavior Analysis (ABA) services to children with autism and developing individualized treatment plans. This role will support utilization management activities, including clinical reviews, authorization reviews, and medical necessity determinations for behavioral health services.

• Current Board Certified Behavior Analyst (BCBA) certification required.
• Active state licensure as a BCBA in one of the following states:
• Maryland (MD)
• District of Columbia (DC)
• Virginia (VA)
• BCBA certification and state licensure must be active and aligned.

• Minimum 3 years of experience as a licensed and board-certified BCBA.
• Experience providing Applied Behavior Analysis (ABA) services.
• Experience treating children diagnosed with Autism Spectrum Disorder (ASD).
• Demonstrated experience developing and implementing individualized treatment plans.

• Prior experience in:
• Utilization Management (UM)
• Clinical Reviews
• Authorization Reviews
• Medical Necessity Reviews
• Experience using clinical criteria and decision-support tools such as:
• MCG Guidelines
• Inter Qual
• Experience working with:
• Electronic Medical Record (EMR) systems
• Electronic clinical documentation platforms
• Healthcare authorization and utilization management systems

• Conduct utilization management reviews for behavioral health and ABA services.
• Evaluate treatment plans and supporting clinical documentation to determine medical necessity.
• Perform authorization and concurrent reviews in accordance with organizational policies and clinical guidelines.
• Assess member needs and ensure appropriate utilization of behavioral health services.
• Collaborate with providers and care teams regarding treatment recommendations and service authorizations.
• Maintain accurate and timely documentation within electronic medical record (EMR) systems and authorization platforms.
• Apply clinical judgment and evidence-based practices to support quality care outcomes.
• Ensure compliance with regulatory, accreditation, and payer requirements.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.