Behavior Analyst

• Conduct comprehensive clinical reviews of ABA treatment requests to determine medical necessity and alignment with evidence-based practices
• Evaluate treatment goals, progress metrics, and data collection methods
• Oversee and direct unlicensed clinical staff involved in utilization management
• Communicate with ABA providers to gather clinical information and provide feedback on documentation and treatment planning
• Ensure compliance with state and federal regulations, payer-specific guidelines, and internal policies
• Participate in developing and refining utilization management protocols and clinical review tools
• Collaborate with claims, provider relations, and member services to resolve clinical and administrative issues
• Support appeals and grievance processes by preparing clinical rationales and participating in case reviews
• Stay current with ABA research, clinical guidelines, and payer policy changes through continuing education and professional development
• Represent the organization in external audits, accreditation reviews, and inter-agency meetings as needed
• Perform other job-related duties within the scope of responsibilities

Explore Board Certified Assistant, Behavior Analyst, Utilization Reviewer at Blue Cross and Blue Shield of…. Review requirements and application details.