To support the delivery of Autism and Applied Behavioral Analysis (ABA) services, the full-time Licensed Behavioral Health Coordinator will evaluate member conditions, authorize medically necessary services, and collaborate with providers while working remotely in the Tri-State Area of Pennsylvania, New Jersey, or Delaware.
Key Responsibilities:
Evaluates medical records to determine the medical necessity for Autism and ABA services, utilizing criteria such as InterQual and Care Management Policy
Collaborates with providers to clarify treatment plans and ensure valid diagnoses for ABA services, while providing education to caregivers and families
Maintains compliance with regulatory standards and ensures timely processing of referral and authorization requestsRequired QualificationsActive unrestricted independent clinical mental health license (LCSW, LSW, LMFT, LPC, or Psychologist)
Board Certified Behavior Analyst Certification
3+ years of post-independent licensure experience in facility-based and/or outpatient psychiatric and/or substance use disorder treatment
3+ years of BCBA certification experience providing ABA services, including oversight of paraprofessionals
Experience in case management or utilization management for members with autism spectrum disorder or complex psychiatric cases preferred
