Applied Behavior Analyst (BCBA) – Utilization Management (Health Plan ABA)
Location: Alameda, CA 94502 (On-site)
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Pay: $70.00/hour
Summary
We’re hiring an Applied Behavior Analyst (BCBA) for a health plan–based Utilization Management (UM) role supporting Behavioral Health Treatment (BHT) / Applied Behavioral Analysis (ABA) services under EPSDT. This is not a clinic/RBT supervision position. To qualify, your resume must clearly show managed care / health plan UM experience reviewing ABA authorizations, treatment plans, and medical necessity (experience only within ABA provider agencies is typically not sufficient for this role).
If you are an Applied Behavior Analyst (BCBA) who has worked inside a health plan (or delegated UM entity) and understand ABA authorization workflows, guidelines, and regulatory requirements, this is a strong fit.
Responsibilities
- Perform operational Utilization Management for BHT/ABA services (EPSDT)
- Review initial FBA/ABA assessments and ABA treatment plans for best-practice alignment and medical necessity
- Review diagnostic evaluations/assessments and confirm recommendations for BHT/ABA services
- Partner with Behavioral Health case management/triage/navigation teams to support provider linkage and care coordination
- Develop/maintain workflows, training protocols, and operational processes for ABA program delivery
- Collaborate cross-functionally to support regulatory compliance and quality initiatives (e.g., NCQA-related work)
- Analyze utilization trends, barriers, and service plans; recommend improvement strategies
- Prepare reports for internal, contractual, regulatory, and accreditation requirements
- Support delegated entity oversight, audits, and policy/practice reviews as needed
Qualifications (must be on your resume)
- Active BCBA or BCBA-D (required)
- 3+ years providing ABA/BHT therapy to children diagnosed with ASD (required)
- Health plan / managed care UM experience (required) supporting ABA/BHT authorizations (examples: UM/authorization review, medical necessity determinations, delegated UM oversight, payer policy/guideline application)
- Strong knowledge of BHT/ABA best practices, documentation standards, and medical necessity criteria
- Experience working with healthcare delivery systems and cross-functional stakeholders (preferred)
- Master’s/Doctoral degree in a related field (preferred)