You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

This is an excellent opportunity for a licensed Board Certified Behavioral Analyst (BCBA) seeking a flexible, part-time, remote contract with our client. The primary responsibility is to conduct retrospective clinical quality reviews (overreads) of pediatric behavioral therapy medical necessity determinations to ensure they meet state and national guidelines.

Key Responsibilities

• Conduct thorough clinical overreads of completed Pediatric Behavioral Therapy UM determinations.
• Perform retrospective reviews of case documentation previously evaluated by the primary UM vendor.
• Apply InterQual and/or State-Specific Criteria to make independent determinations on whether to agree or disagree with the original decision.
• Focus clinical analysis on key Applied Behavior Analysis (ABA) codes, such as 97151, 97153, and 97155.
• Provide highly detailed, objective clinical documentation defending and supporting your final determinations.

Qualifications

• Must hold an active, unencumbered BCBA or BCBA-D certification in their state.
• Demonstrated experience conducting utilization reviews or utilization management.
• Proven training and experience applying InterQual or similar structured criteria to establish medical necessity.
• Practical experience and familiarity with the core ABA therapy billing codes: 97151, 97153, and 97155.
• Ability to write clear, precise, and objective clinical rationale to support UM overread decisions.

Preferred Skills

• Active Registered Nurse (RN) License (Compact or State-specific).
• Strong technical proficiency navigating standard Microsoft business software (Outlook, Teams, and SharePoint).

Additional Requirements

The schedule is flexible, with 10–15 hours per week available, Monday through Friday.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

• Medix is committed to ensuring a safe, healthy and efficient working environment for our employees, clients and business partners. Under the Drug-Free Workplace Act of 1988, Medix has implemented a Drug-Free Workplace Policy.
• Equal Opportunity Employer/Veterans/Disabled/LGBTQ+

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.