Exception Template
Utilization Review Clinician - ABA- J00962
Job Description Summary
Position Purpose:
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.
Education/Experience:
Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required.
Master’s degree for behavioral health clinicians preferred.
Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required.
Knowledge of ABA services and BH utilization review process required.
Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.
License/Certification:
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 or
Board Certified Behavior Analyst (BCBA) required
Independent licensure with ABA experience and BCBA preferred.
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
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Story Behind the Need
- What is the purpose of this team?
- What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
BH Care Management Team
Backfill for FTE UM Review Clinician
Manages a caseload of 73+ active cases and 30+ pending cases for members with possible and verified Autism diagnosis. Provides resources, attends meetings, runs ABA Rounds where high acuity ABA members are discussed.
No additional hiring needs.
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
- Manage a caseload of 73+ active members and 30+ pending cases, ensuring timely outreach, follow-up, and care coordination.
- Conduct monthly outreach to all active members at minimum once per month to assess needs, provide resources, address barriers to care, and follow up on ongoing care plans.
- Support members in maintaining independent daily functioning by identifying needs, connecting members with appropriate community and healthcare resources, and monitoring progress.
- Conduct member outreach through telephone-based care management and digital care management platforms to provide ongoing support and engagement.
- Assess member needs and coordinate appropriate services, resources, referrals, and follow-up interventions to support positive health and care outcomes.
- Participate in multidisciplinary care team meetings to discuss member needs, care plans, barriers, and progress.
- Participate in and facilitate ABA rounds, contributing to case discussions, care planning, and coordination of member services.
- Maintain accurate and timely documentation of member outreach, assessments, interventions, resources provided, and follow-up activities.
- Prioritize and manage daily workload independently while balancing active caseload responsibilities, pending cases, outreach requirements, care coordination, and team meetings.
- Identify members requiring additional intervention or escalation and collaborate with appropriate care team members to address complex needs.
Candidate Requirements
Education/Certification
Required :
BCBA — Board Certified Behavior Analyst
Preferred:
Licensure
Required:
Licensed Behavior Analyst
Preferred:
Years of experience required: 2 – 4 years of related experience
Disqualifiers: NA
Additional qualities to look for:
- Top 3 must-have hard skills stack-ranked by importance
1
Ability to manage a 90+ member caseload, identify member needs, coordinate services, and transition members into active care management.
2
Experience conducting high-volume outreach, working BH members and conditions, and engaging members in appropriate healthcare services.
3
Proficiency with healthcare case-management/CRM systems, maintaining task queues, documenting outreach, tracking member status, and managing daily productivity/conversion metrics.
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Video Interview on Teams
Required Testing or Assessment (by Vendor):
None, onboarding is 4 weeks
Next Steps
- Do you have any upcoming PTO?
- Colleagues to cc/delegate
Mark Reed, Kailee Pearson (current BCBA, should be on interview)
Compliance Questions
