Autism Program Specialist II

L.A. Care Health Plan•Los Angeles, CA

1d•$77,265 - $123,625•Onsite

About The Position

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose. Job Summary The 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.

Requirements

Master's Degree in Psychology or Applied Behavior Analysis or Related Field
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.
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
Board Certified Behavioral Analyst - Active, current and unrestricted California license.

Nice To Haves

Bachelor's Degree
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

Responsibilities

Conduct 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.