Remote Utilization Review Clinician — ABA/BCBA Expert

Centene Corporation; Georgia; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote/hybrid/field or office work安排

Job summary

Centene Corporation is seeking an ABA review specialist to evaluate care and health status for ABA services, ensuring medical appropriateness across BH and autism needs. The role involves prior authorization reviews, data analysis, and provider interaction to discuss care levels.

Strong QA, education delivery, and policy input are expected within a remote, US-time zone framework. Active BCBA or equivalent licensure is required, with state-specific licensure as applicable.

Qualifications

• Requires graduate of an accredited school of nursing or Bachelor's degree with 2–4 years of related experience.
• BCBA certification required or equivalent licensure per 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 behavioral health for ABA guidelines.
• Analyzes behavioral health data to improve quality and utilization of services.
• Interacts with behavioral health providers to discuss level of care and services.
• Provides education to members and families re ABA and BH utilization processes.
• Provides feedback to leadership on process improvements and policy development.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Strong communication

Computer skills

QA experience

Education

Bachelor's degree

Master’s degree

Tools

QA tools

Job description

Centene Corporation is seeking an ABA review specialist to evaluate care and health status for ABA services, ensuring medical appropriateness across BH and autism needs. The role involves prior authorization reviews, data analysis, and provider interaction to discuss care levels.

Strong QA, education delivery, and policy input are expected within a remote, US-time zone framework. Active BCBA or equivalent licensure is required, with state-specific licensure as applicable.