ABA Utilization Review Clinician - Remote (PST/MST/CST)

Centene Corporation; Salem (OR); Hybrid; USD 37,000 - 68,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote, hybrid, field or office work

Job summary

Centene Corporation seeks a clinical reviewer to evaluate Applied Behavior Analysis (ABA) services, ensuring medical appropriateness and monitoring care quality for behavioral health and autism needs. The role requires nursing or a bachelor's degree with 2-4 years of related experience, and accepts multiple state licenses including BCBA.

BCBA preferred; licensure with independent practice is advantageous. The position involves education for members and families, collaboration with providers, and

Qualifications

• Requires Nursing or Bachelor's with 2-4 years related experience.
• BCBA preferred; various state licenses acceptable.
• Knowledge of ABA services and BH utilization review process.

Responsibilities

• Evaluate member care and health status before, during and after ABA services.
• Perform prior authorization reviews for BH to verify medical appropriateness.
• Analyze BH data to improve quality and utilization.
• Interacts with BH providers to discuss level of care and services.
• Educate members and families on ABA and BH processes.
• Provide feedback to leadership for process improvements.
• Complies with policies and performs other duties.

Education

Bachelor's degree

Graduate of an Accredited School of Nursing

BCBA

LCSW

LMHC

LPC

LMFT

LMHP

RN License

Independent licensure with ABA experience

LBA

Job description

Centene Corporation seeks a clinical reviewer to evaluate Applied Behavior Analysis (ABA) services, ensuring medical appropriateness and monitoring care quality for behavioral health and autism needs. The role requires nursing or a bachelor's degree with 2-4 years of related experience, and accepts multiple state licenses including BCBA.

BCBA preferred; licensure with independent practice is advantageous. The position involves education for members and families, collaboration with providers, and