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Utilization Management Specialist - Behavioral Health(BCBA)

Remote • Posted 12 hours ago • Updated 8 hours ago

Contract W2

12 Months

Remote

Depends on Experience

Fitment

Dice Job Match Score™

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Job Details

Skills

BCBA
BOARD CERTIFIED BEHAVIOR ANALYST
BEHAVIOR ANALYST
CLINICAL BCBA
SENIOR BCBA
AUTISM
ASD
AUTISM SPECTRUM DISORDER
ABA
APPLIED BEHAVIOR ANALYSIS

Summary

Company Description
Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, Enterprise Transformation.

Role: Utilization Management Specialist - Behavioral Health(BCBA)
Location: 100% Remote
Duration: 6-Month Contract-to-Hire

Position Overview
We are seeking a highly skilled and experienced Utilization Management Specialist – Behavioral Health to join our team. The ideal candidate will be a Board Certified Behavior Analyst (BCBA) with experience providing Applied Behavior Analysis (ABA) services to children with autism and developing individualized treatment plans. This role will support utilization management activities, including clinical reviews, authorization reviews, and medical necessity determinations for behavioral health services.

Required Qualifications
Certifications & Licensure

Current Board Certified Behavior Analyst (BCBA) certification required.
Active state licensure as a BCBA in one of the following states:
- Maryland (MD)
- District of Columbia (DC)
- Virginia (VA)
BCBA certification and state licensure must be active and aligned.

Experience

Minimum 3 years of experience as a licensed and board-certified BCBA.
Experience providing Applied Behavior Analysis (ABA) services.
Experience treating children diagnosed with Autism Spectrum Disorder (ASD).
Demonstrated experience developing and implementing individualized treatment plans.

Preferred Qualifications

Prior experience in:
- Utilization Management (UM)
- Clinical Reviews
- Authorization Reviews
- Medical Necessity Reviews
Experience using clinical criteria and decision-support tools such as:
- MCG Guidelines
- InterQual
Experience working with:
- Electronic Medical Record (EMR) systems
- Electronic clinical documentation platforms
- Healthcare authorization and utilization management systems

Key Responsibilities

Conduct utilization management reviews for behavioral health and ABA services.
Evaluate treatment plans and supporting clinical documentation to determine medical necessity.
Perform authorization and concurrent reviews in accordance with organizational policies and clinical guidelines.
Assess member needs and ensure appropriate utilization of behavioral health services.
Collaborate with providers and care teams regarding treatment recommendations and service authorizations.
Maintain accurate and timely documentation within electronic medical record (EMR) systems and authorization platforms.
Apply clinical judgment and evidence-based practices to support quality care outcomes.
Ensure compliance with regulatory, accreditation, and payer requirements.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10483685
Position Id: 26-00536
Posted 12 hours ago

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