Utilization Review Clinician - ABA

Centene Corporation•Remote-FL, FL

6d•$27 - $49•Hybrid

About The Position

Centene is seeking a Utilization Review Clinician - ABA to join their Medical Management/Health Services team. This role involves assessing the medical appropriateness of Applied Behavioral Analysis (ABA) services for members, monitoring clinical effectiveness, and ensuring services align with ABA guidelines. The position offers a fresh perspective on workplace flexibility and is part of a diversified, national organization serving 28 million members.

Requirements

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 have obtained the state required licensure as outlined by the applicable state (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- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or Board Certified Behavior Analyst (BCBA) required.
RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or Independent licensure with ABA experience and BCBA preferred.
Licensed Behavior Analyst (LBA) where required by state required.

Nice To Haves

Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.
BCBA Certificate
ABA Treatment Experience
Technological Savvy
Excellent Written and Oral Communicate
Assessments Skills

Responsibilities

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.