Autism Program Specialist II ALD (1 year term with full benefits)

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 77,265 - 123,625; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA is seeking an Autism Program Specialist II ALD for a 1-year term with full benefits. The clinician will conduct clinical reviews for ASD-related ABA/BHT services, determine medical necessity, and coordinate documentation with providers and UM staff.

The role requires a Master’s in Psychology or ABA, and BCBA credentialing with at least 2 years of ABA experience. This position sits in Behavioral Health and offers robust standard benefits and growth

Qualifications

• Understand the EPSDT process and eligibility criteria.
• Proficient in reviewing progress reports and assessing treatment appropriateness.
• Excellent verbal and written communication and presentation skills.
• Proficient in Microsoft Office and computer skills.

Responsibilities

• Conduct clinical review of diagnostic evaluations and BHT treatment plans to determine medical necessity and accuracy of documentation.
• Review and approve BHT/ABA treatment plans for clinical justification and alignment with goals.
• Apply BCBA-level judgment to evaluate ABA service requests and progress notes for medical necessity.
• Ensure compliance with state and federal standards governing BHT/ABA referral, authorization, and documentation.

Skills

EPSDT process

Progress reports review

Verbal & written communication

Microsoft Office

Education

Master's Degree in Psychology or Applied Behavior Analysis

Bachelor's Degree

Job description

Select how often (in days) to receive an alert:

Autism Program Specialist II ALD (1 year term with full benefits)

Job Category: Clinical

Department: Behavioral Health

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13188

Salary Range: $77,265.00(Min.) -$100,444.00(Mid.) -$123,625.00(Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Behavioral Health Treatment Program Specialist II is responsible for conducting clinical reviews of comprehensive diagnostic evaluations, Behavioral Health Treatment (BHT) plans, and related medical records. The Clinical reviewer determines medical necessity, evaluates requested service intensity against clinical severity and documented progress, and ensures appropriate documentation. The reviewer will confirm compliance with the established clinical policy and state/federal regulatory standards governing Medi-Cal Behavioral Health Treatment (BHT) services. These services apply to individuals with Autism Spectrum Disorder (ASD) and related conditions where individuals require Applied Behavioral Analysis (ABA) or other related BHT services. Behavioral Health Treatment Program Specialist applies clinical benchmarks and medical necessity criteria consistently and conduct peer-to-peer clinical discussions with providers as needed to coordinate care.

Duties

Conduct clinical review of comprehensive diagnostic evaluations and BHT treatment plans to determine medical necessity, clinical appropriateness, and accuracy of documentation.

Review and approve BHT/ABA treatment plans, ensuring requested services are clinically justified, properly documented, and consistent with diagnostic findings and treatment goals.

Apply BCBA-level clinical judgment to evaluate ABA service requests, treatment hours, goals, and progress notes for medical necessity and clinical soundness.

Ensure clinical determinations comply with applicable state and federal regulatory standards governing BHT/ABA referral, authorization, and documentation requirements.

Identify documentation gaps or clinical concerns in submitted records and communicate findings to providers and internal UM/claims staff.

Perform other duties as assigned.

Education Required

Master's Degree in Psychology or Applied Behavior Analysis or Related Field

Education Preferred

Bachelor's Degree

Experience

Required:

At least 2 years of experience as a BCBA with ABA services, assessments, treatment, programing, and familiarity with regulations.

Experience in face-to-face ABA case management in the field.

Skills

Required:

Understand the Early Periodic Screening Detection & Treatment (EPSDT) process and the eligibility criteria.

Proficient in reviewing progress reports and assessing appropriateness of clinical treatment and recommendations.

Excellent verbal, written communication and presentation skills.

Proficient in Microsoft Office and computer skills

Licenses/Certifications Required

Board Certified Behavioral Analyst - Active, current and unrestricted California license.

Licenses/Certifications Preferred

And/Or any of the following Licenses/ Certifications:

Licensed Pharmacy Doctorate/Psychology Doctorate - Active, current and unrestricted California

Licensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License

Licensed Marriage and Family Therapy (LMFT) - Active, current and unrestricted California License

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.

L.A. Care offersa wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program

Nearest Major Market: Los Angeles
Job Segment: Behavioral Health, Social Worker, Claims, Pharmacy, HR, Healthcare, Service, Insurance, Human Resources