Remote ABA Utilization Review Clinician

Centene Corp.; Northern (KY); Hybrid; USD 37,000 - 68,000; Full time

Job summary

Centene Corp. is seeking an Utilization Review Clinician to evaluate ABA services for medical appropriateness and oversee prior authorization reviews.

The role requires strong behavioral health knowledge and collaboration with healthcare providers to ensure effective care for members with autism spectrum disorder. Candidates should have a nursing degree or bachelor’s in a related field with relevant ABA experience, plus state licensure as BCBA or equivalent where required.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience.
• Licensure: BCBA or equivalent as required by state; LMHC, LPC, LMFT, LMHP, LCSW, RN licensure options listed.

Responsibilities

• Review member care and health status for ABA services to ensure medical appropriateness.
• Perform prior authorization reviews for BH to determine medical necessity.
• Analyze BH member data to improve quality and utilization of ABA services.

Job description

Centene Corp. is seeking an Utilization Review Clinician to evaluate ABA services for medical appropriateness and oversee prior authorization reviews.

The role requires strong behavioral health knowledge and collaboration with healthcare providers to ensure effective care for members with autism spectrum disorder. Candidates should have a nursing degree or bachelor’s in a related field with relevant ABA experience, plus state licensure as BCBA or equivalent where required.