Clinical

This role provides support for member clinical review processes specific to applied behavioral analysis (ABA) services, verifying that behavioral health services are medically necessary and align with established clinical guidelines, insurance policies, and regulations. The position ensures members reach desired outcomes through integrated delivery of care across the continuum while contributing to the overarching strategy for quality and cost-effective member care. Responsibilities include assessing ABA services, analyzing clinical service requests, approving prior authorization requests, and participating in interdepartmental collaboration to enhance care.