Utilization Review Clinician – ABA
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Job Description
Utilization Review Clinician evaluating ABA care and prior authorizations for Centene healthcare members. Improving behavioral health service quality, utilization, and medical appropriateness.
Responsibilities:
- Perform reviews of members’ care and health status for Applied Behavioral Analysis services to determine medical appropriateness
- Monitor clinical effectiveness and efficiency of member care in accordance with ABA guidelines
- Evaluate care and health status before, during, and after ABA services
- Perform prior authorization reviews related to behavioral health
- Analyze behavioral health member data to improve quality and appropriate utilization of services
- Interact with behavioral health healthcare providers regarding level of care and services
- Educate members and families about ABA and the behavioral health utilization process
- Provide leadership feedback on care improvement opportunities, processes, and policies
- Comply with all policies and standards
- Perform other assigned duties
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 state-required licensure as applicable (BCBA)
- Master’s degree for behavioral health clinicians required
- Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans
- Knowledge of ABA services and BH utilization review process
- LCSW, LMHC, LPC, LMFT, LMHP, or BCBA required
- RN state licensure and/or compact state licensure with BCBA required for RN pathway
- Licensed Behavior Analyst (LBA) where required by state
- Independent licensure with ABA experience and BCBA preferred
- Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred
- Ability to work Monday through Friday, 8:00 am to 5:00 pm Eastern Time, with occasional weekends and holidays
Benefits:
- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity and diversity commitment
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