Developmental-Behavioral Pediatrics - Utilization Management
Position: Advisor Medical Expert – Developmental-Behavioral Pediatrician Work Location: 100% Remote (Must reside within the Continental U.S.) Schedule: Monday – Friday, Pacific Standard Time (PST) Business Hours Target Compensation: $250,000 – $270,000 / year (Based on experience) Role Summary We are seeking an experienced physician with specialized expertise as a Developmental-Behavioral Pediatrician , with Autism Spectrum Disorder (ASD), and Applied Behavior Analysis (ABA) therapy to join our clinical team as a Senior Advisor Medical Expert . This role serves as a physician-level clinical authority supporting Medicaid healthcare programs. In this position, you will leverage your specialized clinical knowledge to evaluate complex behavioral health cases, assess medical necessity, and ensure Medicaid beneficiaries have access to safe, appropriate, and evidence-based treatment options. You will collaborate closely with treating providers, health plan clients, utilization management teams, and multidisciplinary healthcare professionals to drive high-quality clinical outcomes and support sound healthcare operations. This is an exceptional opportunity to apply your clinical expertise outside of direct patient care while influencing clinical policy, utilization strategies, and quality of care on a broader scale.
Key Responsibilities
Clinical Decision-Making: Serve as a subject matter expert for Autism Spectrum Disorder (ASD), and Applied Behavior Analysis (ABA) therapy across Medicaid (Medical) programs. Medical Necessity & Appeals Review: Conduct thorough clinical evaluations of complex authorization requests, appeals, and medical necessity reviews involving ASD and behavioral health care. Documentation & Treatment Evaluation: Review detailed clinical documentation, psychological evaluations, and ABA treatment plans to determine alignment with evidence-based criteria. Peer-to-Peer Consultation: Lead professional peer-to-peer discussions with treating physicians, behavior analysts, and healthcare providers regarding treatment plans and clinical determinations. Operational & Team Guidance: Provide actionable clinical input to utilization management, care management, quality improvement, and operations teams. Policy & Program Improvement: Interpret Medicaid regulations and guidelines to contribute to the development and refinement of clinical review criteria, medical policies, and quality programs. Qualifications & Requirements Education: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Licensure: Active, unrestricted California Medical License (Required). Board Certification: Board Certification in Developmental-Behavioral Pediatrics, Neurology, Psychiatry, Child & Adolescent Psychiatry, or a related clinical specialty. Clinical Experience: Minimum of 5 years of post-residency clinical experience actively treating individuals with Autism Spectrum Disorder and/or complex behavioral health conditions. Specialized Knowledge: Deep, working knowledge of ABA therapy modalities, behavioral health care pathways, and evidence-based practice guidelines. Program Experience: Prior experience working with Medicaid programs and familiarity with utilization management, prior authorization processes, or medical appeals review. Core Skills: Advanced analytical skills with the ability to synthesize multi-disciplinary clinical data into sound, defensible decisions. Strong written and verbal communication skills for peer-to-peer dialogues and interdisciplinary collaboration. Demonstrated self-motivation and efficiency working in a fully remote environment. Why Join Us? 100% Remote Flexibility: Enjoy the convenience of a remote work environment with structured PST business hours. Specialized Impact: Translate your clinical knowledge into systemic improvements for individuals with autism and complex behavioral health needs. Interdisciplinary Reach: Engage in peer consultations and work alongside a dedicated team of clinical leaders, health plan partners, and healthcare providers. Advance Healthcare Access: Help ensure vulnerable Medicaid populations receive timely, high-quality, and medically necessary care. Employee Benefits: Full-time candidates are eligible for a generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance and more. For additional information regarding this opportunity, please contact: Holly Benson Healthcare Recruiter, Judge Healthcare P: (610) 628-5496 | Ext: 9514 | E: [email protected] | judge.com