Board Certified Assistant, Behavior Analyst, Utilization Reviewer

Job not on LinkedIn

🔥 14 hours ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross Blue Shield Association, offering a range of health insurance products and services in the state of Louisiana. The company provides health, dental, and travel insurance options, including Medicare Advantage plans such as HMO and PPO. They focus on delivering comprehensive healthcare coverage through various plans to meet varying customer needs, while partnering with doctors, hospitals, and clinics to ensure quality care and support. Additionally, the company emphasizes wellness programs, cost-saving opportunities, and accessibility for its members.

📋 Description

• Conduct comprehensive clinical reviews of ABA treatment requests to determine medical necessity and alignment with evidence-based practices • Evaluate treatment goals, progress metrics, and data collection methods • Oversee and direct unlicensed clinical staff involved in utilization management • Communicate with ABA providers to gather clinical information and provide feedback on documentation and treatment planning • Ensure compliance with state and federal regulations, payer-specific guidelines, and internal policies • Participate in developing and refining utilization management protocols and clinical review tools • Collaborate with claims, provider relations, and member services to resolve clinical and administrative issues • Support appeals and grievance processes by preparing clinical rationales and participating in case reviews • Stay current with ABA research, clinical guidelines, and payer policy changes through continuing education and professional development • Represent the organization in external audits, accreditation reviews, and inter-agency meetings as needed • Perform other job-related duties within the scope of responsibilities

🎯 Requirements

• Bachelor's degree in Applied Behavior Analysis, Psychology, Special Education, Human Services, Social Work, or a related field; four years of related experience may be used in lieu of the Bachelor's degree • Minimum of 2 years of experience working in ABA services, autism services, behavioral health, utilization management, or a related healthcare setting • BCaBA certification required within 1 year of hire • Strong knowledge of ABA terminology, treatment planning, behavior analytic principles, and service delivery models • Experience reviewing clinical documentation and treatment records • Excellent written, verbal, and professional communication skills • Strong analytical, organizational, and critical-thinking abilities • Proficiency with Microsoft Office applications and electronic health record systems • Ability to manage multiple priorities while maintaining attention to detail • Residency in or relocation to Louisiana is preferred • Must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support • Successful completion of background and pre-employment drug screening; offer contingent on satisfactory drug testing results • Must meet physical and cognitive demands, including the ability to comprehend, document, calculate, visualize, and analyze

🏖️ Benefits

• Resources to live well and be healthy • Continuing learning, professional development, and skill development opportunities • Smoke- and tobacco-free company properties • Reasonable accommodations for individuals with disabilities • Full-time employment