Utilization Review Clinician – ABA

🔥 24 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

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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

• Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness • Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines • Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards • Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria • Analyzes BH member data to improve quality and appropriate utilization of services • Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services • Provides education to members and their families regarding ABA and BH utilization process • Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies • Performs other duties as assigned • Complies with all policies and standards

🎯 Requirements

• Graduate of an Accredited School of Nursing or Bachelor's degree • 2-4 years of related experience • 2+ years providing ABA services as a BCBA • License to practice independently and/or have obtained the state required licensure as outlined by the applicable state (BCBA) • 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 • LCSW, LMHC, LPC, LMFT, or LMHP required • RN - Registered Nurse - State Licensure and/or Compact State Licensure with BCBA preferred • Licensed Behavior Analyst (LBA) where required by state required

🏖️ Benefits

• Competitive pay • Health insurance • 401K and stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules