Board Certified Behavioral Analyst

Position Purpose

Responsible managing utilization review and care coordination for members with autism spectrum disorder (ASD) and related behavioral health conditions. Supports the delivery of behavioral health care by contributing expert input to peer reviews, facilitating provider education, and participating in clinical oversight activities. Collaborates with network practitioners and medical leadership to promote evidence-based practices, ensure appropriate utilization of services, and address concerns related to behavioral health interventions.

This is a remote position, however local candidates to the Columbia area are preferred. The normal hours of this position are 8:30am - 5pm, Monday through Friday.

• Conducts clinical reviews for ABA and other autism-related services including: outpatient behavioral health services and psychological testing requests. Participate in peer reviews with psychologists, therapists, and other Behavior Analyst. Monitor provider adherence to evidence-based practices and payer guidelines.
• Provide education and consultation to network providers on best practice models and utilization management processes. Collaborate with Medical Directors and interdisciplinary teams to resolve clinical questions and ensure coordinated care. Assist in responding to provider, member, and regulatory inquiries related to autism-related behavioral health services.
• Contribute clinical expertise during outpatient rounds to support service planning and oversight. Collaborates with case management and care coordination teams to support members with complex needs.
• Participate in regulatory audits and contribute to corrective action planning. Respond to member, provider, and state inquiries or complaints. Perform other duties as assigned.

• Required
  
  Education:
  
  Master's in behavior analysis, psychology or related field
• Required
  
  Work Experience:
  
  3 years of experience in behavioral health. 2 years of practical experience in applied behavioral analysis or other evidence-based treatment for autism spectrum disorder (may be concurrent).
• Required
  
  Skills and Abilities:
  
  Extensive knowledge of applied behavior analysis. Deep understanding of CMS, Medicaid, HIPAA, NCQA, and URAC standards. Proficiency in tools like Inter Qual and Milliman Care Guidelines (MCG) for level-of-care determinations. Efficient handling of high-volume caseloads and adherence to regulatory timelines. Familiarity with ICD-10, CPT codes, and clinical documentation standards for ABA and behavioral health. Strong analytical and problem-solving skills. Proficiency in developing, implementing and reviewing behavior intervention plans.
  
  Ability to stay current with evolving guidelines, technologies, and payer policies. Familiarity with electronic health records and utilization review platforms. Effective written and verbal communication skills. Ability to assess complex cases and make sound determinations under pressure. Ability to work independently and as part of a team. Clear, concise communication with providers, payers, and families; skilled in peer-to-peer reviews and appeals.
  
  Proficient in Microsoft Office Suite (Outlook, Word, Excel, Teams). Ability to utilize multiple digital tools including utilization review platforms and EHR systems.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates: Active Board Certified Behavior Analyst (BCBA) by the Behavior Analyst Certification Board (BACB).

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Blue Cross Blue Shield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.

It is our policy to provide equal…