Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management
Core
Board Certified Behavior Analyst (BCBA) specializing in Behavioral Health Utilization Management, assessing treatment plan appropriateness and clinical necessity for healthcare coverage.
Role type
Senior IC Behavioral Health Utilization Management Analyst
Builds
Healthcare service coverage decisions and treatment plan evaluations
Domain
Healthcare / Behavioral Health / Managed Care
Deliverable
dashboards & analysis
Required skills
Clinical judgment, Evidence-based care standards, ABA compliance, Managed care contracting, Medical necessity assessment, Regulatory compliance, Claims system data entry, Risk identification, Provider coordination
Preferred skills
Health Plan experience
Technologies
Claims systems
Responsibilities
Interpret criteria and policies to determine appropriate healthcare services; Coordinate and monitor options to facilitate healthcare benefits; Gather clinical information to render coverage decisions; Consult with providers on ABA compliance and clinical necessity; Identify members at risk for poor outcomes and facilitate referrals; Ensure accurate data entry into claims systems for payment processing.