Utilization Review Clinician – ABA

🔥 16 hours ago

🏰 Missouri – Remote

🏰 Missouri – 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 (ABA) services to determine medical appropriateness • Monitor clinical effectiveness and efficiency of members’ care in accordance with ABA guidelines • Evaluate members’ 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 provided • Educate members and their families regarding ABA and behavioral health utilization processes • Provide feedback to leadership on opportunities to improve care services • Support process improvement and development of new processes and policies • Comply with all policies and standards • Perform other duties as assigned

🎯 Requirements

• Must be able to work within the Eastern or Central Time Zone • Active BCBA certification required • One of the following required licenses or certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state licensure and/or compact state licensure • Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience • 2+ years providing ABA services as a BCBA for Enterprise Population Health • License to practice independently and/or state-required licensure as outlined by the applicable state (BCBA) required • Master’s degree required for behavioral health clinicians • 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, or BCBA required • RN state licensure and/or compact state licensure with BCBA required • Licensed Behavior Analyst (LBA) where required by state required • Experience in ABA treatment preferred • Strong computer skills preferred • Excellent written and verbal communication skills preferred • Experience with auditing and quality assurance (QA) preferred • Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred • Independent licensure with ABA experience and BCBA preferred

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off • 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 employer committed to diversity