Utilization Review Clinician ABA
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About Us
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Utilization Review Clinician for Applied Behavior Analysis (ABA) plays a crucial role in ensuring that patients receive appropriate and effective behavioral health services. This position involves evaluating treatment plans and clinical documentation to determine the medical necessity and appropriateness of ABA therapy services. The clinician collaborates with healthcare providers, therapists, and families to promote best practices and adherence to clinical guidelines. The Utilization Review Clinician ABA also participates in interdisciplinary team meetings, contributes to quality improvement initiatives, and may provide training or support to staff regarding utilization review processes.
Essential Functions
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Utilization Review Clinician for Applied Behavior Analysis (ABA) plays a crucial role in ensuring that patients receive appropriate and effective behavioral health services. This position involves evaluating treatment plans and clinical documentation to determine the medical necessity and appropriateness of ABA therapy services. The clinician collaborates with healthcare providers, therapists, and families to promote best practices and adherence to clinical guidelines. The Utilization Review Clinician ABA also participates in interdisciplinary team meetings, contributes to quality improvement initiatives, and may provide training or support to staff regarding utilization review processes.
Essential Functions
- Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines.
- Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards
- Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria
- Analyzes BH member data to improve quality and appropriate utilization of services
- Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
- Provides education to members and their families regarding ABA and BH utilization process
- Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies
- Comply with all policies and standards
- Performs other duties as required or assigned.
- Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 years of related experience.
- Master’s degree for behavioral health clinicians required.
- Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans preferred.
- Knowledge of ABA services and BH utilization review process preferred.
- Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.
- LCSW- License Clinical Social Worker required or
- LMHC-Licensed Mental Health Counselor required or
- LPC-Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
- Board Certified Behavior Analyst (BCBA) preferred
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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