Utilization Review Clinician – ABA

🔥 16 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

• 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 according to 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 improvements, and new processes or policies • Comply with all policies and standards • Perform other duties as assigned

🎯 Requirements

• Applicants must reside in Florida • Active BCBA certification required • One of the following required licenses or certifications: LCSW, LMHC, LPC, LMFT, LMHP, RN with state licensure and/or compact state licensure, or BCBA • 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 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 • LBA required where required by state • Experience working with providers and healthcare teams to review care services related to ABA preferred • Experience in ABA treatment, computer savvy, excellent written and verbal communication skills, and auditing and QA highly preferred • Monday through Friday, 8:00 AM to 5:00 PM EST

🏖️ 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 • Equal opportunity and diversity commitment