ABA Care Review Clinician (BCBA/LBA) – Florida

Molina Healthcare; Mid Florida Lakes (FL); On-site; USD 36,000 - 71,000; Full time

Job summary

Molina Healthcare is seeking a qualified professional to support member clinical review processes for ABA services, ensuring medical necessity and alignment with clinical guidelines, policies, and regulations. You will contribute to delivering quality, cost-effective care across the care continuum.

Responsibilities include assessing ABA services, reviewing requests against evidence-based guidelines, determining benefits and eligibility, approving prior authorizations, and collaborating with care

Qualifications

• Minimum 2 years health care experience with behavioral analysis.
• BCBA or LBA license must be active in state of practice.
• Strong knowledge of community resources.
• Ability to work independently with minimal supervision.
• Effective written and verbal communication skills.
• Proactive, detail-oriented, and able to handle multiple projects.

Responsibilities

• Assess ABA services for members to ensure optimum outcomes and compliance with regulations.
• Analyze clinical requests against evidence-based guidelines.
• Determine benefits, eligibility and expected length of stay for treatments.
• Approve prior authorization for BHT with medical necessity per guidelines.
• Collaborate across departments to enhance member care.
• Provide peer-to-peer consultation to in-network providers.
• Monitor treatment plans for effectiveness and outcomes.
• Support recruitment and provider relations to ensure network adequacy.
• Collaborate with ABA providers to ensure best service practices.
• Create forms, recommendations and guidelines for BHT delivery.
• Coordinate with care management to ensure timely access to services.
• Collaborate with behavioral health medical directors for proper BHT management.

Skills

Healthcare experience

BCBA/LBA knowledge

Communication skills

Time management

Detail-oriented

Self-motivation

Team collaboration

Education

BCBA or LBA certification

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a qualified professional to support member clinical review processes for ABA services, ensuring medical necessity and alignment with clinical guidelines, policies, and regulations. You will contribute to delivering quality, cost-effective care across the care continuum.

Responsibilities include assessing ABA services, reviewing requests against evidence-based guidelines, determining benefits and eligibility, approving prior authorizations, and collaborating with care