Pay Rate: $51/hr on W2
Terms of Employment:
W2 Contract-to-Hire, 6 months
This position is 100% remote. Candidates must reside in client-approved states (Preference will be given to DMV area candidates)
Overview:
Work with a premier health insurance and healthcare organization as a Utilization Management Specialist within their dedicated Behavioral Health division. In this vital corporate role, you will transition your clinical expertise from direct patient care to healthcare administrative strategy. Your primary objective will be to review and evaluate clinical authorization requests and Applied Behavioral Analysis (ABA) treatment plans for children with autism, ensuring members receive high-quality, medically necessary, and efficient care.
Key Responsibilities:
Review and evaluate approximately 30 clinical treatment plans and authorization requests per day for behavioral health services.
Analyze clinical documentation specifically regarding Applied Behavioral Analysis (ABA) therapies for pediatric patients with autism spectrum disorders.
Utilize clinical guidelines, medical policies, and Electronic Medical Record (EMR) software to determine appropriate levels of care and service utilization.
Formulate objective clinical determinations and process administrative actions regarding care approvals or reductions.
Professionally communicate complex clinical determinations, including care denials or service adjustments, to healthcare providers and clinical facilities in a pleasant, calm, and diplomatic manner.
Maintain meticulous attention to detail to meet strict compliance and turnaround timelines for organizational decision-making.
Required Qualifications:
Must hold a Master s degree in a behavioral health-related field.
Active, valid national certification as a Board Certified Behavior Analyst (BCBA).
Active, unrestricted professional state licensure as a BCBA in Maryland, Washington D.C., or Virginia (MD, DC, or VA).
Minimum of 3 years of clinical experience practicing explicitly as a licensed BCBA.
Documented clinical experience treating, managing, or developing ABA treatment plans for pediatric populations/children with autism.
Strong computer literacy, including intermediate proficiency with Microsoft Office Suite, navigating electronic documentation systems, and editing PDFs.
Direct patient care experience
ABA treatment plan development experience
Preferred Qualifications:
Prior experience working within Utilization Management (UM), Utilization Review (UR), or Managed Care operations.
Familiarity with clinical care criteria data sets such as MCG (Milliman Care Guidelines), McKesson, or Interqual.
Prior experience utilizing electronic healthcare authorization platform systems (e.g., Health Edge or related EMR tools).
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