Utilization Review Clinician – ABA

🕒 August 25

🐊 Florida – Remote

🐊 Florida – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 24%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Perform reviews of members’ care and health status for Applied Behavioral Analysis services to determine medical appropriateness • Monitor clinical effectiveness and efficiency of members’ care in accordance with ABA guidelines • Evaluate care and health status before, during, and after ABA services • 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 healthcare providers regarding level of care and services provided • Educate members and families regarding ABA and behavioral health utilization processes • Provide leadership feedback on care improvement opportunities • Support process improvement and development of new processes or policies • Comply with policies and standards • Perform other duties as assigned

🎯 Requirements

• Applicants must reside in Florida • BCBA certification required • ABA treatment experience required • 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 as applicable, including 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 BH utilization review process required • LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or RN state/compact licensure with BCBA, as applicable • Licensed Behavior Analyst (LBA) where required by state required • Technological savvy preferred • Excellent customer service and communication skills preferred • Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred • Ability to work Monday through Friday, 8:00 AM to 5:00 PM

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employment • Consideration for qualified applicants with arrest or conviction records in accordance with applicable law