Board Certified Behavior Analyst, Behavioral Health Utilization Management

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

📋 Description

• Utilize critical thinking and clinical expertise in behavioral health utilization management.

• Analyze criteria, policies, procedures, and intricate clinical matters to ascertain suitable services.

• Organize, oversee, and assess options to ensure appropriate healthcare services and benefits for members.

• Collect clinical data and employ clinical criteria, guidelines, policies, procedures, and judgment to make coverage decisions.

• Collaborate with providers and other stakeholders to promote optimal care and inform them about clinical necessity issues and ABA compliance standards.

• Recognize members at risk for adverse outcomes and facilitate referrals to additional products, services, and programs.

• Discover opportunities to enhance quality and effective utilization of healthcare services and benefits.

• Engage with both internal and external parties regarding utilization and benefit management.

• Ensure precise information is recorded in the claims system for payment processing.

⛳️ Requirements

• Master's Level Degree is REQUIRED.

• Board Certified Behavior Analyst (BCBA) is REQUIRED.

• Licensed Behavioral Analyst in Virginia (LBA) is REQUIRED.

• Comprehensive knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements is REQUIRED.

• Understanding of contractual, regulatory, and compliance obligations for government payers, self-funded and commercial payers is REQUIRED.

• Experience in ABA (applied behavior analysis) with ASD (autism spectrum disorder) is REQUIRED.

• A minimum of 3 years of related experience is REQUIRED.

• Experience in Health Plans is preferred.

• Must work remotely from Virginia only.

• Standard working hours: 8am to 5pm EST, Monday-Friday.

🏝️ Benefits

• Medical, Dental, Vision plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid Parental & Family Caregiver Leave.

• Emergency Backup Care.

• Long-Term, Short-Term Disability, and Critical Illness plans.

• Life Insurance.

• 401k/403B with Employer Match.

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education.

• Student Debt Pay Down – $10,000.

• Pet Insurance.

• Legal Resources Plan.

• Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met.