Utilization Review Clinician - ABA

Centene Management Company LLC; Louisiana (MO); Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Health insurance

401K

Tuition reimbursement

Job summary

Centene is seeking an ABA review professional to evaluate member care and health status related to ABA services, ensuring medical appropriateness and adherence to BH guidelines.

The role involves prior authorization reviews, data analysis, and collaboration with BH providers, families, and leadership to improve care and utilization. Licensure as BCBA and applicable state credentials are required.

Qualifications

• Requires graduate of an accredited school of nursing or bachelor’s degree with 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) is required.
• 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 medical appropriateness.
• Performs prior authorization reviews related to BH to determine medical appropriateness per ABA guidelines.
• Analyze BH member data to improve quality and utilization of services.
• Interacts with BH providers to discuss level of care and services.
• Educates members and families regrading ABA and BH utilization process.
• Provides leadership with feedback to improve care through new processes and policies.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

BCBA experience

ABA treatment knowledge

Clinical evaluation

Education

Bachelor's degree

Graduate of an Accredited School of Nursing

Master’s degree in behavioral health

Tools

BCBA licensure

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

• Must be licensed in Louisiana or Georgia.
• BCBA with ABA treatment experience highly preferred.

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.
• Análisis 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
• LMHC-Licensed Mental Health Counselor required
• LPC-Licensed Professional Counselor required
• Licensed Marital and Family Therapist (LMFT) required
• Licensed Mental Health Professional (LMHP) required
• 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
• 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

About Centene

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.

Equal Opportunity Statement

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.