Salary Range: $77,265.00 (Min.) - $100,444.00 (Mid.) - $123,625.00 (Max.)Job SummaryThe Behavioral Health Treatment Program Specialist II is responsible for conducting clinical reviews of comprehensive diagnostic evaluations, Behavioral Health Treatment (BHT) plans, and related medical records. The Clinical reviewer determines medical necessity, evaluates requested service intensity against clinical severity and documented progress, and ensures appropriate documentation. The reviewer will confirm compliance with the established clinical policy and state/federal regulatory standards governing Medi-Cal Behavioral Health Treatment (BHT) services. These services apply to individuals with Autism Spectrum Disorder (ASD) and related conditions where individuals require Applied Behavioral Analysis (ABA) or other related BHT services. Behavioral Health Treatment Program Specialist applies clinical benchmarks and medical necessity criteria consistently and conduct peer-to-peer clinical discussions with providers as needed to coordinate care.
DutiesConduct clinical review of comprehensive diagnostic evaluations and BHT treatment plans to determine medical necessity, clinical appropriateness, and accuracy of documentation.
Review and approve BHT/ABA treatment plans, ensuring requested services are clinically justified, properly documented, and consistent with diagnostic findings and treatment goals.
Apply BCBA-level clinical judgment to evaluate ABA service requests, treatment hours, goals, and progress notes for medical necessity and clinical soundness.
Ensure clinical determinations comply with applicable state and federal regulatory standards governing BHT/ABA referral, authorization, and documentation requirements.
Identify documentation gaps or clinical concerns in submitted records and communicate findings to providers and internal UM/claims staff.
Perform other duties as assigned.
Duties ContinuedEducation RequiredMaster's Degree in Psychology or Applied Behavior Analysis or Related Field
Education PreferredBachelor's Degree
ExperienceRequired:At least 2 years of experience as a BCBA with ABA services, assessments, treatment, programing, and familiarity with regulations.
Experience in face-to-face ABA case management in the field.
SkillsRequired:Understand the Early Periodic Screening Detection & Treatment (EPSDT) process and the eligibility criteria.
Proficient in reviewing progress reports and assessing appropriateness of clinical treatment and recommendations.
Excellent verbal, written communication and presentation skills.
Proficient in Microsoft Office and computer skills
Licenses/Certifications RequiredBoard Certified Behavioral Analyst - Active, current and unrestricted California license.
Licenses/Certifications PreferredAnd/Or any of the following Licenses/ Certifications:
Licensed Pharmacy Doctorate/Psychology Doctorate - Active, current and unrestricted California
Licensed Clinical Social Worker (LCSW) - Active, current and unrestricted California License
Licensed Marriage and Family Therapy (LMFT) - Active, current and unrestricted California License
Required TrainingPhysical RequirementsLight
Additional InformationSalary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
This position is a limited duration position. The term of this position is a minimum one year and maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.
L.A. Care offers a wide range of benefits including- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
