ABA Utilization Management Clinical Consultant

📋 Description

• Utilizes critical thinking and possesses knowledge in clinically appropriate treatments, evidence-based care, and clinical practice guidelines for Behavioral Health, particularly in ABA.

• Employs clinical expertise and skills in a collaborative approach to evaluate the suitability of treatment plans across various levels of care, applying evidence-based standards and practice guidelines where applicable.

• Coordinates, monitors, and assesses options to ensure members receive appropriate healthcare services and benefits.

• Collects clinical information and applies the relevant clinical criteria, guidelines, policies, procedures, and clinical judgment to determine coverage.

• Collaborates with providers and other stakeholders to promote optimal care and treatment.

• Recognizes members at risk for adverse outcomes and facilitates referral opportunities to integrate with other products, services, and programs.

• Identifies opportunities to enhance the quality and effectiveness of healthcare services and benefit utilization.

⛳️ Requirements

• Independent BCBA/LBA certification.

• Over 3 years of clinical practice experience, such as in a hospital setting, with direct clinical practice experience required.

• At least 1 year of experience in Autism treatment/ABA is necessary.

• Ability to manage multiple tasks, prioritize effectively, and adapt to a fast-paced, changing environment.

• Proficiency in computer skills, including navigating multiple systems and keyboarding, is essential.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Comprehensive benefits package.