Care Review Clinician, ABA: FLORIDA

Job Description

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge / Skills / Abilities

• Assesses ABA services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and / or procedures.
• Works collaboratively with the Utilization and Case Management departments to provide ABA / BHT services to Molina members with ASD and other related disorders.
• Approves prior authorization requests for BHT treatment by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to : Psychological Evaluation requests, Comprehensive Diagnostic Evaluations, Functional Behavioral Assessments, and Progress Reports.
• Participates in interdepartmental integration and collaboration to enhance care of Molina members receiving BHT treatment.
• Provides peer to peer consultation to BHT in-network providers to support treatment planning and maximize member progress
• Performs ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy.
• Collaborates with Provider contracting and Providers Services to support recruitment and provider relations in order to ensure network adequacy, quality of care and timeliness of services.
• Works collaboratively with ABA providers to ensure best service practices for members.
• Develops and coordinates internal and external BHT trainings.
• Creates and develops forms, recommendations and guidelines for BHT service delivery.
• Works collaboratively with the Case Management department to ensure members receive appropriate and timely access to BHT services
• Collaborates and coordinates with Behavioral Health Medical Director, and Senior Medical Directors to ensure proper management of the BHT benefit
• Up to 30% local travel may be required.

Job Qualifications

Required Education

Bachelors or Masters Degree in Behavior Analysis, Education, Social Work, Psychology, or other Behavioral Health field

Required Experience

3 years working as Behavior Analyst

Required License, Certification, Association

Licensed, or Board Certified, as a Behavior Analyst

Preferred Education

Masters Degree in Behavior Analysis or a related field.

Preferred Experience

Utilization Management experience

Health Plan / MCO work experience

Preferred License, Certification, Association

Board Certified Behavior Analyst (BCBA) OR Active, Unrestricted, State Licensed Behavior Analyst (LBA)

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $26.41 - $51.49 / HOURLY

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Job Type : Full Time Posting Date : 01 / 27 / 2025

Salary : $26 - $51