Utilization Review Clinician – ABA

🔥 7 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – 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 member care according to ABA guidelines • Evaluate care before, during, and after ABA services for medical appropriateness and clinical standards • Perform BH prior authorization reviews using ABA regulatory guidelines and criteria • Analyze behavioral health member data to improve quality and appropriate service utilization • Interact with behavioral health 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 improvements, and new processes or policies • Comply with all policies and standards and perform other assigned duties

🎯 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 • LCSW, LMHC, LPC, LMFT, LMHP, BCBA, RN state/compact licensure with BCBA, or LBA where required by state • Experience working with providers and healthcare teams to review Applied Behavior Analysis services preferred • BCBA with ABA treatment experience highly 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