Centene Corporation
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.
Utilization Review Clinician – ABA
🕒 September 17
Where this job comes from
Posted on Centene Corporation's careers page, not through a job board
First seen by Remote Rocketship September 17
Still open on Centene Corporation's site. Checked 3 hours ago.
Centene Corporation
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 member care according to ABA guidelines • Evaluate care and health status before, during, and after ABA services • Perform prior authorization reviews related to behavioral health in accordance with ABA regulatory guidelines and criteria • 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 for members receiving ABA 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 • Comply with all policies and standards • Perform other duties as assigned
🎯 Requirements
• Must be licensed in Louisiana or Georgia • 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 (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 • LCSW, LMHC, LPC, LMFT, LMHP, or BCBA required • RN state licensure and/or Compact State Licensure with BCBA required for applicable pathway • Licensed Behavior Analyst (LBA) where required by state required • Independent licensure with ABA experience and BCBA preferred
🏖️ 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 and diversity commitment
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