[Hiring] Behavioral Health Physician @Gainwell Technologies LLC

Role Description

The Behavioral Health (Autism & ABA Therapy Physician) serves as a senior clinical subject matter expert responsible for providing medical oversight and review of behavioral health services, with a primary focus on Autism Spectrum Disorder (ASD) and Applied Behavior Analysis (ABA) therapy. This role partners with clinical, operational, and client teams to ensure medical necessity determinations are evidence-based, clinically appropriate, and aligned with state Medicaid regulations and program requirements. The Advisor Medical Expert supports quality improvement initiatives, provider engagement, and policy development to improve access to high-quality behavioral health services.

• Serve as the physician subject matter expert for Behavioral Health, Autism Spectrum Disorder (ASD), and Applied Behavior Analysis (ABA) therapy programs.
• Review complex authorization requests, appeals, and medical necessity determinations related to behavioral health and autism treatment services.
• Conduct peer-to-peer consultations with providers and apply evidence-based clinical criteria to support appropriate care decisions.
• Provide clinical guidance to utilization management, quality, case management, and operational teams.
• Interpret and apply Medicaid regulations, medical policies, and behavioral health treatment guidelines to support program compliance.
• Collaborate with clients and internal stakeholders to improve healthcare outcomes, quality initiatives, and access to behavioral health services.

Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with an active, unrestricted U.S. medical license.
• Active, unrestricted license to practice medicine in the State of California.
• Board Certification in Psychiatry, Child & Adolescent Psychiatry, Developmental Behavioral Pediatrics, Neurology, or a related specialty.
• Minimum of five years of post-residency clinical experience treating individuals with Autism Spectrum Disorder and behavioral health conditions.
• Strong knowledge of ABA therapy, behavioral health treatment models, and evidence-based clinical guidelines.
• Experience with Medicaid programs, utilization management, prior authorization, appeals, or medical review activities.
• Excellent analytical, communication, and decision-making skills with the ability to work independently in a remote environment.

Requirements

• Remote role supporting Medicaid behavioral health programs. Work must be performed within the United States.
• Full-time temporary assignment expected to last 9-12 months, with potential for extension based on business needs. Standard schedule: Monday-Friday, 8:00 AM-5:00 PM; flexibility required as needed.
• Collaborate with providers, clients, and multidisciplinary healthcare teams.
• Conduct peer-to-peer reviews, complex case consultations, and medical necessity determinations for behavioral health and autism-related services.
• Review clinical documentation and contribute to high-quality, evidence-based care decisions.

Benefits

• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.