Utilization Review Clinician – ABA

🔥 15 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Review members’ care and health status before, during, and after ABA services • Determine medical appropriateness, level of care, and service needs according to ABA guidelines and clinical standards • Perform prior authorization reviews related to behavioral health • Analyze behavioral health member data to improve quality and appropriate utilization of services • Interact with behavioral health providers regarding level of care and services for members receiving ABA • Educate members and families about ABA and the behavioral health utilization process • Provide leadership feedback on care improvement opportunities, process improvements, and new processes or policies • Comply with all policies and standards • Perform other assigned duties

🎯 Requirements

• Applicants must reside in Florida • BCBA certification required • ABA treatment experience required • Technological savvy preferred • Excellent customer service and communication skills preferred • Monday through Friday, 8:00 AM to 5:00 PM work schedule • Graduate of an Accredited School of Nursing or Bachelor's degree and 2–4 years of related experience • For Enterprise Population Health, 2+ years providing ABA services as a BCBA • License to practice independently and/or state-required licensure (BCBA) required • Master’s degree for behavioral health clinicians required • Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required • Knowledge of ABA services and behavioral health utilization review process required • Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis preferred • One of the following required: LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or LBA where required by state • RN state licensure and/or compact state licensure with BCBA required for RN pathway

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to remote, hybrid, field or office work schedules • Potential additional incentives as part of total compensation