BCaBA Utilization Reviewer – ABA Compliance & Review

Louisiana Blue; Baton Rouge (LA); Sur place; USD 52 000 - 76 000; Plein temps

Résumé du poste

Louisiana Blue is seeking a Board-Certified Assistant Behavior Analyst (BCaBA) Utilization Reviewer to assess the medical necessity of ABA services for LA Blue members. Under a BCBA, you will review treatment plans, data, and documentation to ensure clinical integrity and payer guidance compliance.

You will lead clinical reviews, collaborate with providers and internal teams, and support appeals and audits.

Qualifications

• Bachelor's degree in ABA/related field; four years of related experience can substitute.
• Minimum of 2 years' experience in ABA, autism services, or related healthcare setting.
• BCaBA certification required within 1 year of hire.
• Strong knowledge of ABA terminology, treatment planning, and behavior analytic principles.
• Experience reviewing clinical documentation and treatment records.
• Excellent written, verbal, and professional communication skills.
• Proficiency with Microsoft Office and electronic health record systems.
• Ability to manage multiple priorities with attention to detail.

Responsabilités

• Conduct comprehensive clinical reviews of ABA treatment requests to determine medical necessity and alignment with evidence-based practices.
• Evaluate treatment goals, progress metrics, and data collection methods to ensure clinical effectiveness and appropriateness.
• Oversee and direct work activities of unlicensed clinical staff involved in the utilization management process.
• Communicate with ABA providers to gather additional clinical information and provide feedback on documentation and treatment planning.
• Ensure compliance with state and federal regulations, payer-specific guidelines, and internal policies.
• Participate in the development and refinement of utilization management protocols and clinical review tools.
• Collaborate with internal departments such as claims, provider relations, and member services to resolve clinical and administrative issues.
• Support the appeals and grievance process by preparing clinical rationales and participating in case reviews.
• Stay current with developments in ABA research, clinical guidelines, and payer policy changes through continuing education and professional development.
• Represent the organization in external audits, accreditation reviews, and inter-agency meetings as needed.

Connaissances

ABA terminology

Treatment planning

Reviewing docs

Communication skills

EHR systems

Microsoft Office

Organizational skills

Formation

Bachelor's degree in ABA/related field

BCaBA certification within 1 year

Description du poste

Louisiana Blue is seeking a Board-Certified Assistant Behavior Analyst (BCaBA) Utilization Reviewer to assess the medical necessity of ABA services for LA Blue members. Under a BCBA, you will review treatment plans, data, and documentation to ensure clinical integrity and payer guidance compliance.

You will lead clinical reviews, collaborate with providers and internal teams, and support appeals and audits.