Clinical Reviewer and Case Manager, Utilization Management – ABA Services

Company Description

SyncHealthcare is a healthcare management company. Our mission is simple – to improve appropriate access and quality care for patients. We are committed to improving the quality, safety, and efficiency of the healthcare system for patients.

Minimum Education Required for Position

• PhD in Clinical Psychology with ABA experience and BCBA required

• MD/DO with board certification in Psychiatry with ABA experience and BCBA required

• LCSW- License Clinical Social Worker with Board Certified Behavior Analyst (BCBA)

required or

• LMHC-Licensed Mental Health Counselor with Board Certified Behavior Analyst

(BCBA) required or

• LPC-Licensed Professional Counselor required with BCBA required or

• Licensed Marital and Family Therapist (LMFT) with Board Certified Behavior Analyst

(BCBA) required

• Licensed Mental Health Professional (LMHP) with Board Certified Behavior Analyst

(BCBA) required

Job Description + Responsibilities

We are seeking an experienced and detail-oriented Utilization Review and Case Manager to lead and manage a team of utilization review clinicians responsible for reviewing and authorizing Applied Behavior Analysis (ABA) and other Behaviral Health services. This role ensures that service requests align with clinical guidelines, payer policies, and regulatory standards. The ideal candidate will have a strong background in ABA therapy, utilization management, and medical necessity criteria, along with demonstrated leadership and team development skills.

Key Responsibilities:

• Supervise and support a team of utilization review clinicians to ensure timely, accurate, and clinically appropriate determinations for ABA service requests.

• Apply evidence-based medical management principles and clinical criteria (e.g., MCG, InterQual, proprietary guidelines) to the utilization review process.

• Monitor workload distribution, performance metrics, and productivity to ensure departmental goals and service-level agreements (SLAs) are met.

• Collaborate with clinical leadership to develop, implement, and refine review protocols and standard operating procedures.

• Provide ongoing training, coaching, and professional development for UR staff.

• Ensure compliance with federal and state regulations, payer requirements, and internal quality standards.

• Facilitate peer-to-peer reviews and interact with providers, payers, and internal stakeholders as needed to resolve escalated cases.

• Review and analyze trends in service requests and denials; recommend improvements to reduce administrative burden and promote appropriate care.

• Prepare reports for internal leadership and external partners detailing utilization outcomes, performance, and operational metrics.

• Support audits and quality improvement initiatives related to utilization management and clinical review practices.

Position / Certification supervising this position

Chief Medical Officer (MD)

Salary, Benefits, + Opportunities

Job type: Full-Time or Part-time, Flexible hours, evening and weekend available

Location: Remote, US-based

Salary: Hourly

Actual pay will be determined based on an individual's skills, experience, education, and other job-related factors allowed by law, including their full-time or part-time status.

Other Related Open Positions:

Clinical Reviewer: Part-time or Full-time, Utilization Management – Behavioral Health

(Licensed Psychologist, PhD or Psychiatrist or BH Experience MD/DO)

Other Requirements

Qualifications:

Requires Graduate of an Accredited School Nursing or Bachelor's degree in related

field and 2 – 4 years of related experience. OR

• PhD in Clinical Psychology from an accredited institution or

• MD/DO with board certification in Psychiatry with active, unrestricted license to

practice as a psychologist or psychiatrist , multi-state is a plus

• Minimum of 2 year post-licensure experience in behavioral health treatment

settings.

• At least 1 year of experience in utilization review or managed care is strongly

preferred.

• Familiarity with behavioral health treatments including autism spectrum disorder,

ABA, substance use disorder, and serious mental illness.

• Strong working knowledge of utilization review tools (e.g., InterQual, MCG, ASAM), is

a plus

• License to practice independently, and/or have obtained the state required

licensure as outlined by the applicable state (BCBA) required.

• Master’s degree for behavioral health clinicians preferred.

• Behavioral health clinical knowledge and ability to review and/or assess ABA

Treatment Plans required.

• Experience working with providers and healthcare teams to review care services

related to Applied Behavior Analysis Services preferred.

• Multi-state licenses are a plus.

• Familiarity with health plan operations, prior authorization processes, and payer

guidelines, a plus

• Excellent organizational, analytical, and communication skills.

• Proficient in Microsoft Office and electronic medical record (EMR) systems;

experience with utilization review platforms, a plus.

• PhD in Clinical Psychology with ABA experience and BCBA required

• MD/DO with board certification in Psychiatry with ABA experience and BCBA required

• LCSW- License Clinical Social Worker with Board Certified Behavior Analyst (BCBA)

required or

• LMHC-Licensed Mental Health Counselor with Board Certified Behavior Analyst

(BCBA) required or

• LPC-Licensed Professional Counselor required with BCBA required or

• Licensed Marital and Family Therapist (LMFT) with Board Certified Behavior Analyst

(BCBA) required

• Licensed Mental Health Professional (LMHP) with Board Certified Behavior Analyst

(BCBA) required