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. The clinician monitors the effectiveness and efficiency of care in accordance with ABA guidelines and clinical standards. This is a remote position, and applicants must be able to work within the Eastern or Central Time Zone. The schedule is Monday through Friday, 8:00 AM to 5:00 PM EST/CST. The role requires an active BCBA certification and an applicable professional license or certification, such as LCSW, LMHC, LPC, LMFT, LMHP, or RN with state or compact-state licensure. A Licensed Behavior Analyst (LBA) is required where required by the state. Behavioral health clinicians must have a master’s degree. The position involves reviewing ABA treatment plans, conducting prior authorization reviews, analyzing member data, coordinating with providers, educating members and families, and identifying opportunities to improve care and processes.
Requirements
- Active BCBA certification.
- One of the following required licenses or certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state and/or compact-state licensure; applicable independent licensure and BCBA requirements apply.
- Licensed Behavior Analyst (LBA) where required by the state.
- Graduate of an accredited school of nursing or a bachelor’s degree and 2–4 years of related experience.
- Master’s degree required for behavioral health clinicians.
- For Enterprise Population Health, 2 or more years providing ABA services as a BCBA.
- License to practice independently and/or state-required licensure as applicable.
- 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.
Nice To Haves
- Experience in ABA treatment.
- Strong computer skills.
- Excellent written and verbal communication skills.
- Experience with auditing and quality assurance (QA).
- 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 the level of care and services are medically appropriate for behavioral health and/or autism spectrum disorder needs and meet clinical standards.
- Perform behavioral health prior authorization reviews to 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 the level of care and/or services provided to members receiving ABA services.
- Educate members and their families about ABA and the behavioral health utilization process.
- Provide leadership with feedback on opportunities to improve care services through process improvement and the 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 remote, hybrid, field, or office work schedules
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What This Job Offers
Job Type
Full-time
