Senior ABA Clinical Quality Specialist - Hybrid

UnitedHealth Group•Schaumburg, IL

18h•$91,700 - $163,700•Hybrid

About The Position

Healthcare delivery is rapidly evolving, and within Optum Whole Health Solutions, the Site Visit Clinician supports provider quality, operational readiness, and consistent performance across the network. The role combines analytics, provider engagement, operational assessment, and quality improvement to strengthen the provider experience and reinforce key standards. Work in this role is generally self directed and not highly prescribed. The clinician works through less structured and moderately complex issues, assesses provider needs, interprets requirements, and identifies solutions to non standard situations. The role involves translating developing concepts and quality expectations into practical site review activities and conducting analyses that support clear, actionable findings. The Site Visit Clinician also serves as a resource to others by providing explanations on difficult issues, offering guidance as needed, and supporting colleagues with less experience. The clinician works with minimal guidance and seeks input only on the most complex tasks. As a Site Visit Clinician, you will carry out the full lifecycle of ABA site reviews, including pre visit planning, data integration, onsite assessment, post visit reporting, and follow up on quality action plans. Since this work is early in its development and ABA quality standards continue to evolve, success requires comfort with ambiguity, critical thinking, and the ability to apply emerging standards in real provider settings. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Holds active Board Certified Behavior Analyst® (BCBA®) certification in good standing
If required by the state of residence- Maintain unrestricted and in good standing licensure and certification
Direct experience delivering applied behavior analysis (ABA) services in clinic, home, or community based settings and can independently apply this knowledge during site reviews
Brings experience in provider quality oversight, operational review, clinical operations, or similar healthcare support functions involving moderately complex analytical and operational tasks
Deep working understanding of Council of Autism Service Providers (CASP) standards of care and can interpret and apply these standards in varied provider environments
Familiar with Autism Commission on Quality (ACQ) accreditation standards and able to translate accreditation concepts into practical assessment criteria during provider evaluations
Demonstrates the ability to independently integrate data from multiple sources, interpret trends, and synthesize findings into clear, actionable insights
Proven ability to communicate clearly in both written and verbal formats and can conduct structured interviews with provider leaders and staff at all levels
Proven ability to manage multiple workflows with accuracy, attention to detail, and minimal guidance, including adjusting work in response to variable provider operations
Proven capability of interpreting and presenting complex data, trends, and operational metrics in a way that supports decision making and quality improvement
Proven solid interpersonal and collaboration skills, with the ability to work effectively with cross functional partners and serve as a resource for colleagues with less experience
Ability to travel up to 40%25 to conduct onsite provider reviews and follow up activities

Nice To Haves

Experience in behavioral health operations, quality oversight, or provider management
Experience providing training, creating and/or implementing tools, or processes to improve operational consistency
Familiarity with implementing performance improvement frameworks and quality action planning

Responsibilities

Completes site visits
Performs end to end coordination of ABA site reviews, from planning and data collection through onsite activities and post visit reporting
Applies a disciplined, standardized approach to data integration, documentation, and quality verification to ensure consistency across provider evaluations
Maintains and continuously improves the Integrated Checklist List (ICL) and related processes to ensure data completeness, clarity, and usability
Works with less structured, more complex issues that arise from market, state, and practice variations and identifies solutions to non standard requests
Pre visit planning, data analysis, and readiness
Coordinates all preparatory activities and confirms that documentation and required data inputs are complete prior to the onsite review
Collects, analyzes, interprets, and synthesizes quantitative and qualitative data, including ABA code utilization, provider and member long day analyses, and treatment intensity and supervision metrics
Develops concise pre visit summaries that integrate Practice Management and PNI data, provider history, and centralized analytics
Prepares tables, graphs, and interpretive narratives that translate analytic findings into practical review focus areas
Organizes and uploads finalized pre visit documentation to shared systems for team access
Participates in pre visit planning meetings to align expectations, roles, and logistics
Works with minimal guidance and seeks guidance only for the most complex or ambiguous cases
Onsite visit operations and provider facing interactions
Serves as an onsite reviewer conducting structured interviews, observations, and operational assessments
Interviews provider business and clinical leaders to assess compliance, quality, oversight, and workflow effectiveness; completes staff interviews to understand day to day operations
Documents observations aligned with practice standards and program requirements
Collaborates with a cross disciplinary site visit team, typically with at least two reviewers per site, and coordinates with state health plan executive leadership and departmental partners such as Network, Practice Management, Provider Network Integrity, and Data
Solves moderately complex issues in real time and adjusts approach while maintaining standards
Provides clear explanations and information to provider teams on difficult issues
Acts as a resource for others with less experience and offers coaching on interview, observation, and documentation techniques
Post visit reporting and quality improvement follow up
Integrates pre visit data, provider documentation, interviews, observations, and Practice Management reports into clear post visit summaries
Produces actionable written reports that synthesize qualitative and quantitative findings and translate policy and program concepts into practical provider actions
Presents site visit results to internal leadership and to provider business and clinical leadership and provides explanations on complex findings
Supports Quality Action Plans, including documentation, scheduling, and provider coaching; conducts follow up reviews to verify corrective actions and standards adherence
Participates in internal debriefs and the onsite visit oversight committee to clarify findings, identify next steps, and recommend process refinements and training needs
Impact spans operational, local business unit, and market levels
Workload management and stakeholder alignment
Plans and manages personal workload to align site review assignments with visit volume, provider complexity, and enterprise timelines
Assesses and interprets stakeholder requirements and ensures day to day work aligns with market strategy and policy objectives in coordination with cross functional partners
Escalates only the most complex technical, operational, or regulatory issues
ABA Standards, Policy, and Provider Support
Applies ABA standards of care (including CASP and accreditation-related expectations) and relevant clinical and operational policies during site reviews; translates standards into clear, practical feedback for providers
Supports provider advocacy and value-based care goals by assessing treatment models, supervision structures, and utilization patterns with attention to quality, outcomes, and sustainability
Maintains working familiarity with ABA industry trends, evolving standards, and payer expectations, incorporating these insights into site visit focus areas and quality improvement recommendations