Care Review Clinician, ABA

Job Summary Provides support for member clinical review processes specific to applied behavioral analysis (ABA) services. Responsible for verifying that behavioral health services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties u2022 Assesses applied behavioral analysis (ABA) services for members - ensuring optimum outcomes, cost-effectiveness and compliance with all state and federal regulations and guidelines. u2022 Analyzes clinical service requests from members/providers against evidence based clinical guidelines. u2022 Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. u2022 Works collaboratively with the utilization and care management departments to provide ABA and behavioral health therapy (BHT) services to Molina members with autism spectrum disorder (ASD) and other related disorders. u2022 Approves prior authorization requests for BHT treatment by reviewing 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 (CDEs), functional behavioral assessments (FBAs), and progress reports. u2022 Participates in interdepartmental integration and collaboration to enhance care of Molina members receiving BHT treatment. u2022 Provides peer-to-peer consultation to BHT in-network providers to support treatment planning and maximize member progress u2022 Performs ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy. u2022 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. u2022 Works collaboratively with ABA providers to ensure best service practices for members. u2022 Develops and coordinates internal and external BHT trainings. u2022 Creates and develops forms, recommendations and guidelines for BHT service delivery. u2022 Works collaboratively with the care management department to ensure members receive appropriate and timely access to BHT services u2022 Collaborates and coordinates with behavioral health medical directors to ensure proper management of the BHT benefit. u2022 30% estimated local travel may be required (based upon state/contractual requirements). Required Qualifications BCBAs or LCSW, LMHC with BCBA and/or lead analysts experience or School psychologist (non-doctorate) with BCBA and/or lead analysts experience or Psychologist with BCBA and/or lead analysts experience u2022 At least 2 years health care experience, including experience working as a behavioral analyst, or equivalent combination of relevant education and experience. u2022 Demonstrated knowledge of community resources. u2022 Ability to operate proactively and demonstrate detail-oriented work. u2022 Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. u2022 Ability to work independently, with minimal supervision and demonstrate self-motivation. u2022 Responsive in all forms of communication, and ability to remain calm in high-pressure situations. u2022 Ability to develop and maintain professional relationships. u2022 Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. u2022 Excellent problem-solving, and critical-thinking skills. u2022 Strong verbal and written communication skills. u2022 Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications u2022 Utilization management experience. u2022 Health plan/managed care organization experience. #PJHS3 #LI-AC1 To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.

Created: 2026-04-24