Remote ABA Utilization Review Specialist

Centene Management Company LLC; Georgia; Ibrido; USD 37.000 - 67.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/field/office

Descrizione del lavoro

Centene is seeking a remote Care Reviewer to assess member's ABA services for medical appropriateness, monitor effectiveness, and ensure compliance with ABA guidelines. The role requires BCBA certification and licensure such as LCSW, LMHC, LPC, LMFT, LMHP, or RN.

Work hours are 8:00 AM to 5:00 PM EST/CST, Monday to Friday. Candidates with ABA experience, QA skills, and strong communication are preferred.

Competenze

• Must have strong computer skills and QA experience.
• Excellent written and verbal communication abilities are required.
• Knowledge of ABA services and BH utilization review process is preferred.

Mansioni

• Evaluates member's care and health status before, during, and after ABA services.
• Performs prior authorization reviews related to BH to determine medical appropriateness.
• Analyzes BH member data to improve quality and appropriate 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.

Conoscenze

Computer skills

Written communication

Verbal communication

Auditing

Quality Assurance

Formazione

Bachelor's degree or higher

Graduate of Accredited School of Nursing

Descrizione del lavoro

Centene is seeking a remote Care Reviewer to assess member's ABA services for medical appropriateness, monitor effectiveness, and ensure compliance with ABA guidelines. The role requires BCBA certification and licensure such as LCSW, LMHC, LPC, LMFT, LMHP, or RN.

Work hours are 8:00 AM to 5:00 PM EST/CST, Monday to Friday. Candidates with ABA experience, QA skills, and strong communication are preferred.