Board Certified Assistant (BCaBA) Behavior Analyst, Utilization Reviewer

Louisiana Blue; Baton Rouge (LA); On-site; USD 52,000 - 76,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

ABA terminology

Treatment planning

Reviewing docs

Communication skills

EHR systems

Microsoft Office

Organizational skills

Education

Bachelor's degree in ABA/related field

BCaBA certification within 1 year

Job description

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.

Residency in or relocation to Louisiana is preferred for all positions.

Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.

POSITION PURPOSE

The Board-Certified Assistant Behavior Analyst (BCaBA), Utilization Reviewer role is responsible for evaluating the medical necessity and clinical appropriateness of Applied Behavior Analysis (ABA) services for LA Blue members. Working under the guidance of a BCBA Utilization Reviewer, this role conducts preliminary clinical reviews, analyzes treatment documentation, evaluates service utilization trends, and collaborates with providers to obtain and clarify clinical information to ensure compliance with payer guidelines while maintaining clinical integrity and promoting cost-effective care.

How You Contribute to the Company’s Mission In This Role

• 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.

Required Qualifications

• Bachelor's degree in Applied Behavior Analysis, Psychology, Special Education, Human Services, Social Work, or a related field. Four years of related experience can be used in lieu of Bachelor's degree.
• Minimum of 2 years of experience working in ABA services, autism services, behavioral health, utilization management, or a related healthcare setting.
• Board Certified Assistant Behavior Analyst (BCaBA) certification required within 1 year of hire.
• Strong knowledge of ABA terminology, treatment planning, behavior analytic principles, and service delivery models.
• Experience reviewing clinical documentation and treatment records.
• Excellent written, verbal, and professional communication skills.
• Strong analytical, organizational, and critical-thinking abilities.
• Proficiency with Microsoft Office applications and electronic health record systems.
• Ability to manage multiple priorities while maintaining attention to detail.

Preferred Qualifications

• Familiarity with medical terminology, particularly terms related to ABA therapy and developmental