Remote ABA Utilization Review Clinician

IntelliResume; Georgia; On-site; USD 37,000 - 68,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene seeks a remote Utilization Review Clinician - ABA to assess care and health status for ABA services in Georgia. The role emphasizes medical appropriateness and prior authorization review to ensure quality utilization.

You will contribute to care decisions, educate members and families, and collaborate with behavioral health providers while complying with policies and standards. RN/BCBA licensure and nursing or bachelor credentials are required or preferred.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree required.
• 2-4 years of related experience required.
• 2+ years providing ABA services as a BCBA preferred.

Responsibilities

• Evaluate member’s care and health status before, during, and after ABA services.
• Perform prior authorization reviews related to behavioral health to determine medical appropriateness.
• Analyze behavioral health member data to improve quality and utilization of services.
• Interact with behavioral health providers to discuss level of care and services.
• Provide education to members and families regarding ABA and utilization process.
• Provide feedback to leadership on opportunities to improve care services.
• Comply with all policies and standards.

Skills

ABA knowledge

Clinical reviews

Healthcare compliance

Education

Bachelor's degree

Accredited school of Nursing

Job description

Centene seeks a remote Utilization Review Clinician - ABA to assess care and health status for ABA services in Georgia. The role emphasizes medical appropriateness and prior authorization review to ensure quality utilization.

You will contribute to care decisions, educate members and families, and collaborate with behavioral health providers while complying with policies and standards. RN/BCBA licensure and nursing or bachelor credentials are required or preferred.