Remote ABA Utilization Review Clinician

Centene Management Company LLC; North Carolina; Hybrid; USD 61,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K/Stock plans

Tuition reimbursement

Paid time off

Job summary

Centene Management Company LLC is seeking a licensed professional to review member care and health status for Applied Behavioral Analysis (ABA) services to ensure medical appropriateness and alignment with clinical standards. You will assess prior authorizations, analyze data, and communicate with BH providers.

This remote role requires work within the Eastern or Central Time Zone, BCBA certification, and licensure appropriate to state requirements.

Qualifications

• Requires graduate of an accredited school of nursing or bachelor’s degree with 2–4 years of related experience.
• BCBA license to practice independently or state licensure as outlined by the applicable state.
• 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 medically appropriate care.
• Performs prior authorization reviews related to BH to determine medical appropriateness per ABA guidelines.
• 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 regarding ABA and BH utilization process.
• Implements process improvements and contributes to policy development.

Skills

Written communication

Verbal communication

Computer skills

Auditing

Education

Bachelor's degree

Master's degree

BCBA certification

Job description

Centene Management Company LLC is seeking a licensed professional to review member care and health status for Applied Behavioral Analysis (ABA) services to ensure medical appropriateness and alignment with clinical standards. You will assess prior authorizations, analyze data, and communicate with BH providers.

This remote role requires work within the Eastern or Central Time Zone, BCBA certification, and licensure appropriate to state requirements.