Utilization Review Clinician - ABA

Centene Corporation•Remote-FL, FL

7d•$27 - $49•Remote

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, but applicants must reside in Florida. Candidates must be BCBA certified and have ABA treatment experience. Technological savvy and excellent customer service and communication skills are preferred. The work schedule is Monday through Friday, 8:00 AM to 5:00 PM.

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
LMHC-Licensed Mental Health Counselor required
LPC-Licensed Professional Counselor required
Licensed Marital and Family Therapist (LMFT) required
Licensed Mental Health Professional (LMHP) required
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
Licensed Behavior Analyst (LBA) where required by state required

Nice To Haves

Technological savvy
Excellent customer service and communication skills
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.