ABA Utilization Review Clinician – Remote Options

Centene Management Company LLC; Louisiana (MO); Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Health insurance

401K

Tuition reimbursement

Job summary

Centene is seeking an ABA review professional to evaluate member care and health status related to ABA services, ensuring medical appropriateness and adherence to BH guidelines.

The role involves prior authorization reviews, data analysis, and collaboration with BH providers, families, and leadership to improve care and utilization. Licensure as BCBA and applicable state credentials are required.

Qualifications

• Requires graduate of an accredited school of nursing or bachelor’s degree with 2–4 years of related experience.
• 2+ years providing ABA services as a BCBA for Enterprise Population Health.
• State licensure as outlined by the applicable state (BCBA) is required.
• Master’s degree for behavioral health clinicians is required.

Responsibilities

• Evaluates member’s care and health status before, during, and after ABA services to ensure medical appropriateness.
• Performs prior authorization reviews related to BH to determine medical appropriateness per ABA guidelines.
• Analyze BH member data to improve quality and utilization of services.
• Interacts with BH providers to discuss level of care and services.
• Educates members and families regrading ABA and BH utilization process.
• Provides leadership with feedback to improve care through new processes and policies.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

BCBA experience

ABA treatment knowledge

Clinical evaluation

Education

Bachelor's degree

Graduate of an Accredited School of Nursing

Master’s degree in behavioral health

Tools

BCBA licensure

Job description

Centene is seeking an ABA review professional to evaluate member care and health status related to ABA services, ensuring medical appropriateness and adherence to BH guidelines.

The role involves prior authorization reviews, data analysis, and collaboration with BH providers, families, and leadership to improve care and utilization. Licensure as BCBA and applicable state credentials are required.