Board Certified Behavioral Analyst

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* 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
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