Remote ABA Utilization Review Clinician

Centene Corp.; Town of Florida (NY); Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Remote work

Flexible work arrangements

Job summary

Centene Corp. seeks an Utilization Review Clinician – ABA for a fully remote role with Florida residency preferred. You will evaluate member care, perform prior authorization reviews, and collaborate with BH providers to ensure medically appropriate ABA services.

Requirements include a nursing degree or bachelor’s with 2–4 years ABA/BH experience; BCBA licensure is preferred and a master’s in behavioral health is required for clinicians. Schedule is M-F 8–5 ET with occasional weekends.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree with 2–4 years of related experience; BCBA experience preferred.
• Master’s degree in behavioral health required for clinicians; strong ABA knowledge and BH utilization review skills.
• Licensure: BCBA or equivalent state licensure; RN licensure and/or BCBA preferred.

Responsibilities

• Evaluate member care and health status before, during, and after ABA services to ensure medical appropriateness.
• Perform prior authorization reviews related to BH to determine medical necessity per ABA guidelines.
• Analyze BH member data to improve quality and utilization of ABA services.
• Interact with BH healthcare providers to discuss level of care and services.
• Provide education to members and families regarding ABA and BH utilization process.
• Give feedback to leadership on process improvements and policy development.

Skills

ABA knowledge

Utilization review

Prior authorization

Provider collaboration

Education

Bachelor's degree in nursing or related field

Master's degree in behavioral health

BCBA certification

Tools

BCBA

Job description

Centene Corp. seeks an Utilization Review Clinician – ABA for a fully remote role with Florida residency preferred. You will evaluate member care, perform prior authorization reviews, and collaborate with BH providers to ensure medically appropriate ABA services.

Requirements include a nursing degree or bachelor’s with 2–4 years ABA/BH experience; BCBA licensure is preferred and a master’s in behavioral health is required for clinicians. Schedule is M-F 8–5 ET with occasional weekends.