Clinical Reviewer, Utilization Management Behavioral Health and ABA (Licensed Psychologist, PhD[...]

SyncHealthcare; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare management company seeks a Clinical Reviewer for ABA services. This remote role involves evaluating and authorizing behavioral health services, emphasizing quality care and adherence to guidelines. Ideal candidates will hold relevant licenses and have experience in utilization management.

Qualifications

• Requires graduate degree in relevant field or clinical license.
• 1 year of experience in behavioral health treatment preferred.
• Knowledge of ABA treatment plans and utilization review tools.

Responsibilities

• Review and authorize ABA and behavioral health services.
• Analyze member data to improve service utilization.
• Educate patients about ABA and behavioral health utilization.

Skills

Organizational Skills

Analytical Skills

Communication Skills

Education

PhD in Clinical Psychology

MD/DO with board certification in Psychiatry

Master's degree for behavioral health clinicians

Tools

Microsoft Office

Utilization Review Platforms

Electronic Medical Record (EMR) systems

Job description

Job Title: Clinical Reviewer, Utilization Management – Behavioral Health and ABA (Licensed Psychologist, PhD or Psychiatrist or LCSW or LMHC or LPC or LMFT, or LMHP or BCBA)

Location: Remote
Status: Full-Time or Part-time, Flexible hours, evening and weekend available
Company: SyncHealthcare
Location: Remote, US-based
Reports to: Chief Medical Officer

You could be the one who changes everything for our members as a clinical professional on our team. SyncHealthcare is a healthcare management company. Our mission is simple – to improve appropriate access and quality care for patients. We are committed to improving the quality, safety, and efficiency of the healthcare system for patients.

Position Summary:
We are seeking experienced and detail-oriented behavioral health clinicians responsible for reviewing and authorizing Applied Behavior Analysis (ABA) and other Behavioral Health services. This role ensures that service requests align with clinical guidelines, payer policies, and regulatory standards. The ideal candidate will have a strong background in ABA therapy. Knowledge of utilization management or medical necessity criteria is preferred.

Primary Responsibilities:
Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines.
Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards.
Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria.
Analyzes BH member data to improve quality and appropriate utilization of services.
Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
Provides education to patients and their families regarding ABA and BH utilization process.
Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies.
Performs other duties as assigned.
Comply with all policies and standards.
Exhibit sound organizational and excellent communication skills.

Qualifications:
Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience. OR
PhD in Clinical Psychology from an accredited institution or
MD/DO with board certification in Psychiatry with active, unrestricted license to practice as a psychologist or psychiatrist, multi-state is a plus
Minimum of 1 year post-licensure experience in behavioral health treatment settings.
At least 1 year of experience in utilization review or managed care is strongly preferred.
Familiarity with behavioral health treatments including autism spectrum disorder, ABA, substance use disorder, and serious mental illness.
Strong working knowledge of utilization review tools (e.g., InterQual, MCG, ASAM), is a plus
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required.
Master’s degree for behavioral health clinicians preferred.
Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required.
Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.
Multi-state licenses are a plus.
Familiarity with health plan operations, prior authorization processes, and payer guidelines, a plus
Excellent organizational, analytical, and communication skills.
Proficient in Microsoft Office and electronic medical record (EMR) systems; experience with utilization review platforms, a plus.

License/Certification:
PhD in Clinical Psychology or
MD/DO with board certification in Psychiatry.
LCSW- License Clinical Social Worker required or
LMHC-Licensed Mental Health Counselor required or
LPC-Licensed Professional Counselor required or
Licensed Marital and Family Therapist (LMFT) required or
Licensed Mental Health Professional (LMHP) required or
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Board Certified Behavior Analyst (BCBA) required.
Independent licensure with ABA experience and BCBA preferred.

Salary: Hourly
Actual pay will be determined based on an individual's skills, experience, education, and other job-related factors allowed by law, including their full-time or part-time status.

Other Related Open Positions:
Medical Director, Utilization Management – Behavioral Health (Licensed Psychologist, PhD or Psychiatrist)

How to Apply: Please send your inquiries or resume to [e-mail]