Join our Clinical Excellence team and champion best-in-class authorization practices. 

Proud Moments ABA seeks a skilled and talented Manager, Peer Review and Denials to join our Clinical Excellence team. The Manager, Peer Review and Denials plays a key role in supporting successful authorization outcomes by leading clinical peer reviews and guiding our teams through the insurance approval process. This position prepares and supports BCBAs ahead of peer-to-peer calls, conducts reviews with payers, and presents strong clinical justification for medically necessary ABA services. When authorizations are reduced or denied, the Manager partners with clinicians to develop written appeals, compile supporting documentation, and strengthen clinical rationale. The role also monitors payer trends, advises clinical teams on best practices for documentation and medical necessity, and collaborates closely with leadership to enhance overall authorization success rates.

Proud Moments ABA is a behavioral health organization, providing the gold standard of Applied Behavior Analysis (ABA) services for children on the autism spectrum from birth to age 21. Proud Moments is a haven of knowledge and expertise for parents of children diagnosed on the autism spectrum. We offer expert treatment, innovative techniques, and compassionate, child-centered care.

Here’s how you’ll make an impact as our Manager of Peer Review and Denials:

• Prepare BCBAs for insurance peer review calls by reviewing treatment plans, progress data, and clinical rationales to ensure readiness and alignment with payer expectations
• Lead peer-to-peer clinical review calls with insurance payers, clearly presenting medical necessities, treatment recommendations, and supporting data to secure authorizations
• Advocate for medically necessary ABA services by articulating evidence-based justifications and addressing payer questions or objections
• Support BCBAs to develop and submit written appeals for denied or reduced authorizations, ensuring accuracy, clarity, and compliance with payer requirements
• Coordinate and organize supporting documentation for appeals, including assessments, progress notes, treatment plans, and outcome data
• Analyze and track payer trends, including authorization patterns, common denial reasons, and changes in medical policies
• Partner with organizational leadership to develop strategies that optimize authorization outcomes and ensure consistency across clinical teams
• Maintain detailed records of peer reviews, outcomes, and appeals to support auditing, reporting, and continuous improvement initiatives

To excel in this role, you’ll need the following qualifications and strengths:

• Active BCBA or BCBA-D certification in good standing

• 3–5 years of clinical ABA experience, including assessment and treatment planning

• Strong understanding of medical necessity criteria, insurance authorization processes, and payer requirements for ABA services

• Exceptional written and verbal communication skills, with the ability to present complex clinical information clearly and persuasively

• Excellent organizational skills with the ability to manage multiple reviews, deadlines, and documentation requirements

• Proven leadership experience, including guiding or mentoring clinical teams

Your dedication deserves recognition—here’s what we offer in return:

• Competitive pay commensurate with your education, experience, and location
• Experience a meaningful work-life balance through a flexible, fully remote schedule
• Generous paid time off
• Advancement opportunities as Proud Moments ABA expands
• Comprehensive benefits package, including:
  • Medical, dental and vision coverage
  • 401K retirement savings program
  • Employee Assistance Programs

You deserve to work with the best – Proud Moments ABA.

If you’re ready to accelerate your professional career with a fast-growing, highly respected behavioral health organization, Proud Moments ABA encourages you to submit your qualifications for this position today. Qualified candidates will be contacted via email.

Proud Moments ABA provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, veteran status, sex, national origin, age, disability or genetics. In addition to federal law requirements, Proud Moments ABA complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Salary Range: $105,000 - $115,000 Annually

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