Utilization Review Clinician - ABA
About The Position
Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. This is a remote position; however, applicants must be able to work within the Eastern or Central Time Zone. Candidates must hold an active BCBA certification, and one of the following required licenses or certifications: LCSW (Licensed Clinical Social Worker), LMHC (Licensed Mental Health Counselor), LPC (Licensed Professional Counselor), LMFT (Licensed Marital and Family Therapist), LMHP (Licensed Mental Health Professional), or RN (Registered Nurse) with state licensure and/or compact state licensure. For ABA-related positions, candidates may also qualify with a BCBA (Board Certified Behavior Analyst) certification. Candidates with experience in ABA treatment, strong computer skills, excellent written and verbal communication skills, and experience with auditing and quality assurance (QA) are highly preferred. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM EST / CST.
Requirements
- Requires 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
- 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.
- Independent licensure with ABA experience and BCBA preferred.
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 regrading 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.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
