Utilization Review Clinician - ABA
About The Position
The Utilization Review Clinician reviews members’ care and health status related to Applied Behavioral Analysis (ABA) services to determine medical appropriateness and monitor clinical effectiveness and efficiency in accordance with ABA guidelines. The role evaluates members’ needs before, during, and after services; conducts prior authorization reviews; analyzes behavioral health data; and works with healthcare providers, members, and families on care and utilization processes. This is a remote position for applicants who reside in Florida. The schedule is Monday through Friday, 8:00 AM to 5:00 PM EST. Candidates must hold an active BCBA certification and a qualifying license or certification as described in the posting.
Requirements
- Graduate of an accredited school of nursing or a bachelor's degree and 2–4 years of related experience.
- For Enterprise Population Health, at least 2 years providing ABA services as a BCBA.
- License to practice independently and/or state-required licensure as applicable; BCBA is required.
- Master’s degree for behavioral health clinicians.
- Behavioral health clinical knowledge and ability to review and/or assess ABA treatment plans.
- Knowledge of ABA services and the behavioral health utilization review process.
- Active BCBA certification and one of the following: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state or compact-state licensure.
- Licensed Behavior Analyst (LBA) where required by state.
- Must reside in Florida.
- Available to work Monday through Friday, 8:00 AM to 5:00 PM EST.
Nice To Haves
- Experience in ABA treatment.
- Computer savvy.
- Excellent written and verbal communication skills.
- Auditing and quality assurance experience.
- Experience working with providers and healthcare teams to review care services related to ABA.
- Independent licensure with ABA experience and BCBA.
Responsibilities
- Evaluate members’ care and health status before, during, and after ABA services to ensure services are medically appropriate and consistent with clinical standards for behavioral health and/or autism spectrum disorder needs.
- Perform prior authorization reviews related to behavioral health and determine medical appropriateness 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, as appropriate, to discuss level of care and services provided to members receiving ABA services.
- Educate members and their families regarding ABA and the behavioral health utilization process.
- Provide feedback to leadership on opportunities to improve care services through process improvement and development of new processes and/or policies.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible approach to work, including remote, hybrid, field, or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
