Behavior Analyst - Utilization Review (BCaBA)

Bcbsla; Los Angeles (CA); Híbrido; USD 65 000 - 90 000; Tempo integral

Resumo da oferta

Blue Cross and Blue Shield of Louisiana (Louisiana Blue) is seeking a Board-Certified Assistant Behavior Analyst (BCaBA) Utilization Reviewer to assess medical necessity and clinical appropriateness of ABA services for LA Blue members. You will work under a BCBA Utilization Reviewer to ensure cost-effective, evidence-based care.

The role involves reviewing treatment documentation, guiding unlicensed staff, and collaborating with providers to obtain clinical information.

Qualificações

• Bachelor's degree in ABA, Psychology, Special Education, Human Services, Social Work, or related field.
• Four years of related experience can substitute for a degree.
• Minimum of 2 years in ABA services or related healthcare.
• BCaBA certification required within 1 year of hire.
• Strong knowledge of ABA terminology and treatment planning.
• Experience reviewing clinical documentation and records.
• Excellent written and verbal communication, professional demeanor.
• Strong analytical, organizational, and critical-thinking abilities.
• Proficiency with Microsoft Office and electronic health records.

Responsabilidades

• Conduct comprehensive clinical reviews to determine medical necessity and alignment with evidence-based practices.
• Evaluate treatment goals, progress metrics, and data collection methods for effectiveness.
• Oversee and direct work of unlicensed clinical staff in utilization management.
• Communicate with ABA providers to gather information and provide feedback on documentation.
• Ensure compliance with regulations, payer guidelines, and internal policies.
• Develop and refine utilization management protocols and tools.
• Collaborate with claims, provider relations, and member services to resolve issues.
• Support appeals by preparing clinical rationales and participating in case reviews.
• Stay current with ABA research and policy changes through CE and training.
• Represent the organization in audits and inter-agency meetings as needed.

Conhecimentos

Communication skills

Analytical thinking

Organizational skills

Critical thinking

Attention to detail

Formação académica

Bachelor's degree in ABA/ Psychology/ Special Education/ Human Services/ Social Work

BCaBA certification within 1 year of hire

Ferramentas

Microsoft Office

Electronic Health Records

Descrição da oferta de emprego

Blue Cross and Blue Shield of Louisiana (Louisiana Blue) is seeking a Board-Certified Assistant Behavior Analyst (BCaBA) Utilization Reviewer to assess medical necessity and clinical appropriateness of ABA services for LA Blue members. You will work under a BCBA Utilization Reviewer to ensure cost-effective, evidence-based care.

The role involves reviewing treatment documentation, guiding unlicensed staff, and collaborating with providers to obtain clinical information.