Board Certified Behavioral Analyst
About The Position
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Responsible managing utilization review and care coordination for members with autism spectrum disorder (ASD) and related behavioral health conditions. Supports the delivery of behavioral health care by contributing expert input to peer reviews, facilitating provider education, and participating in clinical oversight activities. Collaborates with network practitioners and medical leadership to promote evidence-based practices, ensure appropriate utilization of services, and address concerns related to behavioral health interventions. Location: This is a remote position, however local candidates to the Columbia area are preferred. The normal hours of this position are 8:30am - 5pm, Monday through Friday.
Requirements
- Master’s in behavior analysis, psychology or related field
- 3 years of experience in behavioral health.
- 2 years of practical experience in applied behavioral analysis or other evidence-based treatment for autism spectrum disorder (may be concurrent).
- Extensive knowledge of applied behavior analysis.
- Deep understanding of CMS, Medicaid, HIPAA, NCQA, and URAC standards.
- Proficiency in tools like InterQual and Milliman Care Guidelines (MCG) for level-of-care determinations.
- Efficient handling of high-volume caseloads and adherence to regulatory timelines.
- Familiarity with ICD-10, CPT codes, and clinical documentation standards for ABA and behavioral health.
- Strong analytical and problem-solving skills.
- Proficiency in developing, implementing and reviewing behavior intervention plans.
- Ability to stay current with evolving guidelines, technologies, and payer policies.
- Familiarity with electronic health records and utilization review platforms.
- Effective written and verbal communication skills.
- Ability to assess complex cases and make sound determinations under pressure.
- Ability to work independently and as part of a team.
- Clear, concise communication with providers, payers, and families; skilled in peer-to-peer reviews and appeals.
- Proficient in Microsoft Office Suite (Outlook, Word, Excel, Teams).
- Ability to utilize multiple digital tools including utilization review platforms and EHR systems.
- Microsoft Office.
- Active Board Certified Behavior Analyst (BCBA) by the Behavior Analyst Certification Board (BACB).
Responsibilities
- Conducts clinical reviews for ABA and other autism-related services including: outpatient behavioral health services and psychological testing requests.
- Participate in peer reviews with psychologists, therapists, and other Behavior Analyst.
- Monitor provider adherence to evidence-based practices and payer guidelines.
- Provide education and consultation to network providers on best practice models and utilization management processes.
- Collaborate with Medical Directors and interdisciplinary teams to resolve clinical questions and ensure coordinated care.
- Assist in responding to provider, member, and regulatory inquiries related to autism-related behavioral health services.
- Contribute clinical expertise during outpatient rounds to support service planning and oversight.
- Collaborates with case management and care coordination teams to support members with complex needs.
- Participate in regulatory audits and contribute to corrective action planning.
- Respond to member, provider, and state inquiries or complaints.
- Perform other duties as assigned.
Benefits
- We offer our employees great benefits and rewards.
- You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- Subsidized health plans, dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
