Autism Program Specialist II

Job Summary

The Behavioral Health Treatment Program Specialist II is responsible for conducting clinical reviews of comprehensive diagnostic evaluations, Behavioral Health Treatment (BHT) plans, and related medical records. The Clinical reviewer determines medical necessity, evaluates requested service intensity against clinical severity and documented progress, and ensures appropriate documentation. The reviewer will confirm compliance with the established clinical policy and state/federal regulatory standards governing Medi-Cal Behavioral Health Treatment (BHT) services. These services apply to individuals with Autism Spectrum Disorder (ASD) and related conditions where individuals require Applied Behavioral Analysis (ABA) or other related BHT services. Behavioral Health Treatment Program Specialist applies clinical benchmarks and medical necessity criteria consistently and conduct peer-to-peer clinical discussions with providers as needed to coordinate care.

Duties

Conduct clinical review of comprehensive diagnostic evaluations and BHT treatment plans to determine medical necessity, clinical appropriateness, and accuracy of documentation.

Review and approve BHT/ABA treatment plans, ensuring requested services are clinically justified, properly documented, and consistent with diagnostic findings and treatment goals.

Apply BCBA-level clinical judgment to evaluate ABA service requests, treatment hours, goals, and progress notes for medical necessity and clinical soundness.

Ensure clinical determinations comply with applicable state and federal regulatory standards governing BHT/ABA referral, authorization, and documentation requirements.

Identify documentation gaps or clinical concerns in submitted records and communicate findings to providers and internal UM/claims staff.

Perform other duties as assigned. 

Duties Continued

Education Required

Education Preferred

Experience

Required:

At least 2 years of experience as a BCBA with ABA services, assessments, treatment, programing, and familiarity with regulations.

Experience in face-to-face ABA case management in the field.

Skills

Required:

Understand the Early Periodic Screening Detection & Treatment (EPSDT) process and the eligibility criteria.

Proficient in reviewing progress reports and assessing appropriateness of clinical treatment and recommendations.

Excellent verbal, written communication and presentation skills.

Proficient in Microsoft Office and computer skills

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information