Senior Behavioral Health – ABA Clinical Review & Authorization Support

Role: Senior Behavioral Health ABA Clinical Review & Authorization Support

Location: Remote (Candidate should be willing to work in EST time zone)

Years of experience: 5years

Role Summary

Seeking fully licensed behavioral health clinicians to support Applied Behavior Analysis (ABA) clinical reviews and authorization assessments. Resources must independently practice under an active LCSW or LMHC license and possess direct ABA related clinical experience to assess treatment plans evaluate medical necessity and support authorization and appeal activities.

This role supports clinical decision making for ABA services across pediatric adolescent and adult populations with developmental cognitive emotional and behavioral disorders.

Mandatory Requirements

Licensure

• Active unrestricted professional license required at time of submission
  • Licensed Clinical Social Worker (LCSW) OR
  • Licensed Mental Health Counselor (LMHC)
• Licenses must allow independent clinical practice
• Associate provisional intern pending or in process licenses are not acceptable

Experience

• Minimum of 2 years of experience with Applied Behavior Analysis (ABA) services
• ABA experience must include clinical responsibility not paraprofessional only roles

Acceptable ABA experience includes:

• Developing reviewing or approving behavioral treatment plans
• Conducting clinical assessments or reassessments
• Supporting ABA service delivery in a licensed clinical capacity
• Collaboration with BCBAs therapists care teams and families

Population Experience

Candidates must have direct experience working with:

• Children adolescents and/or adults
• Individuals with:
  • Autism spectrum disorder
  • Developmental disabilities
  • Cognitive emotional or behavioral disorders

Core Responsibilities

• Review and evaluate ABA treatment plans and clinical documentation
• Assess medical necessity for ABA services
• Conduct or review ongoing clinical assessments and progress evaluations
• Apply Sunshine Health clinical guidelines and criteria to authorization decisions
• Support reauthorizations clinical reviews and appeals as applicable
• Ensure documentation is complete compliant and audit ready
• Collaborate with internal clinical teams and external ABA providers

Education Requirements

• Masters degree required
  • MSW (for LCSW candidates)
  • Masters degree in Counseling or related clinical field (for LMHC candidates)
• Degree must support licensure eligibility