Remote ABA Utilization Review Specialist

Centene Corporation; Town of Texas (WI); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Job summary

Centene Corporation seeks a licensed behavioral health professional to review ABA care, oversee medical appropriateness, and ensure quality of services for members in a remote role aligned with EST/CST working hours.

The incumbent will conduct prior authorizations, analyze BH data, and educate members and families about ABA utilization. A BCBA or relevant licensure is required, with nursing or behavioral health credentials preferred.

Qualifications

• Requires ABA knowledge and experience.
• Experience auditing and quality assurance (QA).
• Strong communication skills (written and verbal).
• Licensure in related field or BCBA certification as applicable.
• Graduate degree in behavioral health or nursing required.

Responsibilities

• Evaluates member care and health status before, during, and after ABA services.
• Performs prior authorization reviews for behavioral health to assess medical necessity.
• Analyzes behavioral health data to improve quality and utilization.
• Interacts with BH providers to discuss level of care and services.
• Provides education to members and families re ABA and BH utilization process.
• Provides feedback to leadership on opportunities to improve care and policies.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

ABA treatment experience

Strong computer skills

Written communication

Verbal communication

Audit and QA experience

Education

Graduate of an Accredited School of Nursing

Bachelor's degree

Master’s degree in behavioral health

Job description

Centene Corporation seeks a licensed behavioral health professional to review ABA care, oversee medical appropriateness, and ensure quality of services for members in a remote role aligned with EST/CST working hours.

The incumbent will conduct prior authorizations, analyze BH data, and educate members and families about ABA utilization. A BCBA or relevant licensure is required, with nursing or behavioral health credentials preferred.