Utilization Review Clinician - ABA

Centene Management Company LLC; Georgia; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/field/office

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Computer skills

Written communication

Verbal communication

Auditing

Quality Assurance

Education

Bachelor's degree or higher

Graduate of Accredited School of Nursing

Job description

Position Purpose

Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines.

Key Details

This is a remote position; however, applicants must be able to work within the Eastern or Central Time Zone. Candidates must hold an active BCBA certification, and one of the following required licenses or certifications: LCSW (Licensed Clinical Social Worker), LMHC (Licensed Mental Health Counselor), LPC (Licensed Professional Counselor), LMFT (Licensed Marital and Family Therapist), LMHP (Licensed Mental Health Professional), or RN (Registered Nurse) with state licensure and/or compact state licensure. For ABA-related positions, candidates may also qualify with a BCBA (Board Certified Behavior Analyst) certification. Candidates with experience in ABA treatment, strong computer skills, excellent written and verbal communication skills, and experience with auditing and quality assurance (QA) are highly preferred. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM EST / CST.

Evaluates Member’s Care and Responsibilities

• Evaluates member's care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards
• Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria
• Analyzes BH member data to improve quality and appropriate utilization of services
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
• Provides education to members and their families regrading ABA and BH utilization process
• Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies
• Performs other duties as assigned. Complies with all policies and standards.

Education/Experience

• Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience
• For Enterprise Population Health 2+ years providing ABA services as a BCBA License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required. Master's degree for behavioral health clinicians required
• Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required
• Knowledge of ABA services and BH utilization review process required
• Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred

License/Certification

LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or Board Certified Behavior Analyst (BCBA) required RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or Independent licensure with ABA experience and BCBA preferred. preferred Licensed Behavior Analyst (LBA) where required by state required.

Pay Range

$27.02 - $48.55 per hour

Benefits Package

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

Company Culture & Equal Opportunity

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Thanks for your interest in Centene and its subsidiary companies. We're so glad that you've decided to fill out an application and take the next step to find your purpose. Also, we're here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail]. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.