Utilization Review Clinician – ABA

🔥 0 minutes 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

• Perform reviews of members’ care and health status for Applied Behavioral Analysis (ABA) 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 to ensure appropriate level of care and services • Perform prior authorization reviews related to behavioral health (BH) • Analyze BH member data to improve quality and appropriate utilization of services • Interact with BH healthcare providers regarding level of care and services for members receiving ABA services • Educate members and families about ABA and the BH utilization process • Provide leadership feedback on care-service improvement opportunities, process improvement, and development of new processes or policies • Comply with all policies and standards • Perform other duties as assigned

🎯 Requirements

• 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 outlined by the applicable state (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 • BCBA certification required • LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or LBA licensure/certification as applicable • RN state licensure and/or compact state licensure with BCBA required for RN pathway • Independent licensure with ABA experience and BCBA preferred • Experience with ABA treatment • Technological proficiency preferred • Managed care experience preferred • Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred • Adaptability in a fast-paced environment • Excellent customer service, communication, and organizational skills • Ability to work Monday through Friday, 8:00 AM to 5:00 PM

🏖️ Benefits

• Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Competitive pay • Additional forms of incentives may be included in total compensation