ABA UM Clinical Consultant

Apply clinical judgment and evidence-based guidelines to assess appropriateness of ABA (Applied Behavior Analysis) treatment plans across levels of care for members with autism. Gather clinical information, apply clinical criteria and policy to render coverage determinations, and coordinate with providers to facilitate optimal care. Monitor and evaluate treatment options, identify members at risk for poor outcomes, and facilitate referrals to integrated programs, services, and products. Consult with internal and external partners on utilization and benefit management. Schedule is Monday–Friday, 8:00am–5:00pm EST, with occasional flexibility based on business needs. Required: independent behavioral health clinician with KY licensure (LCSW, LPCC, LMFT, LPAT, LP, LBA) OR a Registered Nurse with KY or compact license plus psychiatric/behavioral health experience. 3+ years clinical practice experience and autism/ABA treatment experience required. Proficiency with multiple computer systems required. Preferred: managed care/UR experience, independent BCBA/LBA. Pay range $26.01–$56.14/hour, plus bonus/incentive eligibility.