SummaryThe Behavioral Health (Autism & ABA Therapy Physician) serves as a senior clinical subject matter expert responsible for providing medical oversight and review of behavioral health services, with a primary focus on Autism Spectrum Disorder (ASD) and Applied Behavior Analysis (ABA) therapy. This role partners with clinical, operational, and client teams to ensure medical necessity determinations are evidence-based, clinically appropriate, and aligned with state Medicaid regulations and program requirements. The Advisor Medical Expert supports quality improvement initiatives, provider engagement, and policy development to improve access to high-quality behavioral health services.
Your role in our mission- Serve as the physician subject matter expert for Behavioral Health, Autism Spectrum Disorder (ASD), and Applied Behavior Analysis (ABA) therapy programs.
- Review complex authorization requests, appeals, and medical necessity determinations related to behavioral health and autism treatment services.
- Conduct peer-to-peer consultations with providers and apply evidence-based clinical criteria to support appropriate care decisions.
- Provide clinical guidance to utilization management, quality, case management, and operational teams.
- Interpret and apply Medicaid regulations, medical policies, and behavioral health treatment guidelines to support program compliance.
- Collaborate with clients and internal stakeholders to improve healthcare outcomes, quality initiatives, and access to behavioral health services.
What we're looking for- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted U.S. medical license.
- Active, unrestricted license to practice medicine in the State of California.
- Board Certification in Psychiatry, Child & Adolescent Psychiatry, Developmental Behavioral Pediatrics, Neurology, or a related specialty.
- Minimum of five years of post-residency clinical experience treating individuals with Autism Spectrum Disorder and behavioral health conditions.
- Strong knowledge of ABA therapy, behavioral health treatment models, and evidence-based clinical guidelines.
- Experience with Medicaid programs, utilization management, prior authorization, appeals, or medical review activities.
- Excellent analytical, communication, and decision-making skills with the ability to work independently in a remote environment.
What you should expect in this role- Remote role supporting Medicaid behavioral health programs. Work must be performed within the United States.
- Full-time temporary assignment expected to last 9-12 months, with potential for extension based on business needs. Standard schedule: Monday-Friday, 8:00 AM-5:00 PM; flexibility required as needed.
- Collaborate with providers, clients, and multidisciplinary healthcare teams.
- Conduct peer-to-peer reviews, complex case consultations, and medical necessity determinations for behavioral health and autism-related services.
- Review clinical documentation and contribute to high-quality, evidence-based care decisions.
This is a pipeline requisition. Applications will be reviewed on an ongoing basis.
The pay range for this position is $152,000.00 - $217,200.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
