Utilization Review Clinician – ABA

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 10%

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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 • Educate members and families about ABA and the behavioral health utilization process • Provide leadership feedback on care improvement opportunities, process improvement, and new processes or policies • Perform other assigned duties • Comply with all policies and standards

🎯 Requirements

• Must reside in the state of Florida • Must be willing to work Monday–Friday, 8:00–17:00 EST • 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 • Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services 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 the RN/BCBA pathway

🏖️ 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 • Total compensation may include additional forms of incentives