ABA Care Review Clinician - Utilization Management

Molina Healthcare Inc; United States; On-site; USD 80,000 - 110,000; Full time

Job summary

Molina Healthcare Inc. seeks a Clinical Reviewer for ABA services to ensure medical necessity and alignment with clinical guidelines and policies. The role supports integrated care delivery and cost-effective member care across Molina’s network.

Responsibilities include reviewing ABA service requests, collaborating with utilization and care management teams, and providing peer-to-peer consulting to in-network BHT providers. Some travel may be required to fulfill state/contractual requirements.

Qualifications

• 2+ years health care experience, including behavioral analyst work.
• BCBA or Licensed Behavior Analyst with active, unrestricted license.
• Strong communication and time-management skills.

Responsibilities

• Assess ABA services for medical necessity and guidelines.
• Analyze requests against evidence-based guidelines.
• Collaborate with utilization, care management, and provider relations teams.

Skills

Healthcare experience

BCBA or LBA

Communication skills

Detail-oriented

Self-motivation

Education

BCBA or LBA certification

Active license in practice state

Tools

Microsoft Office

Job description

Molina Healthcare Inc. seeks a Clinical Reviewer for ABA services to ensure medical necessity and alignment with clinical guidelines and policies. The role supports integrated care delivery and cost-effective member care across Molina’s network.

Responsibilities include reviewing ABA service requests, collaborating with utilization and care management teams, and providing peer-to-peer consulting to in-network BHT providers. Some travel may be required to fulfill state/contractual requirements.