Health Care Provider A

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.

Assesses applied behavioral analysis (ABA) services for members - ensuring optimum outcomes, cost-effectiveness and compliance with all state and federal regulations and guidelines.

• 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.
• Approves prior authorization requests for BHT treatment by reviewing BHT assessments and treatment plans for medical necessity and BHT best practice guidelines. 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
• 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.
• Works collaboratively with the care management department to ensure members receive appropriate and timely access to BHT services
• Collaborates and coordinates with behavioral health medical directors to ensure proper management of the BHT benefit.
• 30% estimated local travel may be required (based upon state / contractual requirements).

At least 2 years health care experience, including experience working as a behavioral analyst, or equivalent combination of relevant education and experience.

Health plan / managed care organization experience.

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

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