Clinical Care Reviewer II - Board Certified Behavioral Analyst

📋 Description

• • The Clinical Care Reviewer II – Board Certified Behavioral Analyst (BCBA) plays a critical role in ensuring that behavioral health services, including Applied Behavior Analysis (ABA) therapy, are medically necessary, appropriate, and delivered in a cost-effective manner for members enrolled in CareSource Management Group lines of business.
• • Day-to-day responsibilities include completing prospective, concurrent, and retrospective reviews of behavioral health services; evaluating age-appropriate testing and assessment tools for ABA therapy appropriateness; coordinating timely and cost-effective care; referring cases to Medical Directors when clinical criteria are not met; identifying and escalating quality issues; supporting case management referrals; documenting and communicating with health partners, care managers, and discharge planners; and providing guidance to non-clinical staff.
• • CareSource Management Group is a mission-driven healthcare organization dedicated to improving access to quality care for underserved populations, with a strong focus on behavioral health services and compliance with state and federal regulations, accreditation standards, and provider agreements.
• • In this role, the BCBA will deepen expertise in utilization management, evidence-based care criteria (such as MCG and ASAM), healthcare regulations, and interdisciplinary care coordination, while developing leadership and problem-solving skills through complex case reviews and special projects.