Utilization Review Clinician – ABA

🔥 17 hours ago

🤠 Texas – Remote

🤠 Texas – 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 according to ABA guidelines • Evaluate members’ care and health status before, during, and after ABA services • Perform behavioral health prior authorization reviews 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 their families about ABA and the behavioral health utilization process • Provide leadership feedback on care-service improvement opportunities, process improvement, and development of new processes or policies • Comply with all policies and standards • Perform other duties as assigned

🎯 Requirements

• Applicants 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 • For ABA-related positions, BCBA certification may qualify • Experience in ABA treatment highly preferred • Strong computer skills highly preferred • Excellent written and verbal communication skills highly preferred • Experience with auditing and quality assurance (QA) highly preferred • 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 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, BCBA, or RN state/compact state licensure with BCBA required as applicable • Licensed Behavior Analyst (LBA) required where required by state • Independent licensure with ABA experience and BCBA preferred

🏖️ Benefits

• 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