Board Certified Assistant, Behavior Analyst, Utilization Reviewer

This is a fully remote position, open to applicants in Louisiana.

📋 Description

• Perform thorough clinical assessments of ABA treatment requests to evaluate medical necessity and adherence to evidence-based practices.

• Assess treatment objectives, progress indicators, and data collection techniques.

• Supervise and guide unlicensed clinical personnel involved in utilization management.

• Engage with ABA providers to obtain clinical information and offer feedback on documentation and treatment strategies.

• Ensure adherence to state and federal regulations, payer-specific guidelines, and internal policies.

• Contribute to the creation and enhancement of utilization management protocols and clinical review instruments.

• Collaborate with claims, provider relations, and member services to address clinical and administrative concerns.

• Assist in the appeals and grievance processes by preparing clinical justifications and taking part in case evaluations.

• Remain updated on ABA research, clinical guidelines, and changes in payer policies through ongoing education and professional growth.

• Represent the organization during external audits, accreditation reviews, and inter-agency meetings as necessary.

• Carry out other job-related tasks within the scope of responsibilities.

⛳️ Requirements

• Bachelor’s degree in Applied Behavior Analysis, Psychology, Special Education, Human Services, Social Work, or a related field; four years of relevant experience may substitute for the Bachelor’s degree.

• At least 2 years of experience in ABA services, autism services, behavioral health, utilization management, or a comparable healthcare environment.

• BCaBA certification must be obtained within 1 year of employment.

• In-depth knowledge of ABA terminology, treatment planning, behavior analytic principles, and service delivery models.

• Experience in reviewing clinical documentation and treatment records.

• Exceptional written, verbal, and professional communication skills.

• Strong analytical, organizational, and critical-thinking capabilities.

• Proficiency in Microsoft Office applications and electronic health record systems.

• Ability to handle multiple priorities while ensuring attention to detail.

• Preference for residency in or relocation to Louisiana.

• Must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration assistance.

• Successful completion of background checks and pre-employment drug screening; job offer is contingent on satisfactory drug test results.

• Must fulfill physical and cognitive requirements, including the ability to understand, document, calculate, visualize, and analyze.

🏝️ Benefits

• Resources to promote wellness and health.

• Opportunities for ongoing learning, professional development, and skills enhancement.

• Smoke- and tobacco-free company environment.

• Reasonable accommodations available for individuals with disabilities.

• Full-time employment.