Utilization Review Clinician - ABA
About The Position
This is a remote position for a Utilization Review Clinician specializing in Applied Behavioral Analysis (ABA) services. The role involves reviewing the care and health status of members receiving ABA services to determine medical appropriateness, monitor clinical effectiveness, and ensure compliance with ABA guidelines. The clinician will evaluate care before, during, and after ABA services, focusing on behavioral health and autism spectrum disorder needs. Responsibilities include performing prior authorization reviews, analyzing member data to improve service utilization, interacting with healthcare providers, and educating members and families about ABA and the utilization process. The position also involves providing feedback for process improvement and developing new policies. Centene is a diversified, national organization offering competitive benefits and a fresh perspective on workplace flexibility. This is a remote position with hours Monday through Friday, 8:00 a.m. to 5:00 p.m. (EST or CST). Candidates must be licensed in Louisiana.
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.
- Candidates must be licensed in Louisiana.
Nice To Haves
- Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.
Responsibilities
- 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.
- 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
