ABA Care Review Clinician - Utilization & Compliance

Molina Healthcare; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

Molina Healthcare is seeking a qualified professional to support ABA and behavioral health therapy services for members. You will verify medical necessity and align services with clinical guidelines, policies, and regulations to support desired health outcomes across the care continuum.

Requires BCBA or LBA licensure and 2+ years of healthcare experience in behavior analysis. The role involves cross-functional collaboration, training development, and travel up to 30% depending on state

Qualifications

• At least 2 years health care experience in behavioral analysis or equivalent.
• Current BCBA or LBA license active and unrestricted.
• Strong knowledge of community resources and care management.
• Proactive, detail-oriented work style with ability to handle multiple tasks.

Responsibilities

• Assess ABA services for members to ensure optimal outcomes and compliance with regulations.
• Analyze requests against evidence-based clinical guidelines to determine medical necessity.
• Identify benefits, eligibility and expected length of stay for treatments.
• Collaborate with utilization and care management to provide ABA/BHT services for members with ASD.
• Approve prior authorizations by reviewing assessments and treatment plans for medical necessity.

Skills

Healthcare experience

Analytical thinking

Communication skills

Detail-oriented

Independent work

Interpersonal skills

Time management

Microsoft Office

Adaptability

Education

BCBA or LBA license

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a qualified professional to support ABA and behavioral health therapy services for members. You will verify medical necessity and align services with clinical guidelines, policies, and regulations to support desired health outcomes across the care continuum.

Requires BCBA or LBA licensure and 2+ years of healthcare experience in behavior analysis. The role involves cross-functional collaboration, training development, and travel up to 30% depending on state