ABA Utilization Review Specialist

Centene Corporation; Washington; Hybrid; USD 37,000 - 66,000; Full time

Job summary

Centene Corporation is seeking a licensed clinician to review ABA services and health status across the care continuum, ensuring medical appropriateness and alignment with behavioral health guidelines.

The role involves prior authorization reviews, data analysis to improve utilization, and collaboration with BH providers. Time-zone residency in PST, MST, or CST is required, with flexible remote/hybrid options.

Qualifications

• 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) required; RN with BCBA acceptable in some cases.

Responsibilities

• Evaluates member’s care and health status before, during, and after ABA services.
• Performs prior authorization reviews related to BH for ABA guidelines and criteria.
• Analyzes BH member data to improve quality and utilization of services.
• Interacts with BH healthcare providers to discuss level of care and services.
• Provides education to members and families re ABA and BH utilization process.
• Provides feedback to leadership on opportunities to improve care through process improvement.
• Performs other duties as assigned.
• Complies with policies and standards.

Skills

ABA knowledge

BH utilization review

Care evaluation

Education

Bachelor's degree

Master's degree in behavioral health

Job description

Centene Corporation is seeking a licensed clinician to review ABA services and health status across the care continuum, ensuring medical appropriateness and alignment with behavioral health guidelines.

The role involves prior authorization reviews, data analysis to improve utilization, and collaboration with BH providers. Time-zone residency in PST, MST, or CST is required, with flexible remote/hybrid options.