Remote Utilization Review Clinician — ABA Services
Centene Management Company LLC
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Résumé du poste
Centene Management Company LLC is seeking a nurse or behavioral health clinician to review member care and ABA services for medical appropriateness, before, during, and after service delivery. The role emphasizes prior authorization reviews related to BH and collaboration with healthcare providers to ensure appropriate levels of care for autism spectrum disorders.
The position supports education for members and families, data analysis to improve quality, and ongoing process improvements, with a
Qualifications
- Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience.
- 2+ years providing ABA services as a BCBA for Enterprise Population Health.
- State licensure as outlined by the applicable state (BCBA) required.
Responsabilités
- Review member's care and ABA services for medical appropriateness.
- Perform prior authorization reviews for BH in accordance with ABA guidelines.
- Analyze BH data to improve quality and utilization of services.
- Interact with BH providers to discuss level of care and services.
- Provide education to members and families re ABA and BH utilization process.
- Contribute to process improvements and policy development.
Connaissances
Formation
Description du poste
Centene Management Company LLC is seeking a nurse or behavioral health clinician to review member care and ABA services for medical appropriateness, before, during, and after service delivery. The role emphasizes prior authorization reviews related to BH and collaboration with healthcare providers to ensure appropriate levels of care for autism spectrum disorders.
The position supports education for members and families, data analysis to improve quality, and ongoing process improvements, with a
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