Utilization Review Clinician - ABA

Centene Management Company LLC; North Carolina; Hybrid; USD 61,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K/Stock plans

Tuition reimbursement

Paid time off

Job summary

Centene Management Company LLC is seeking a licensed professional to review member care and health status for Applied Behavioral Analysis (ABA) services to ensure medical appropriateness and alignment with clinical standards. You will assess prior authorizations, analyze data, and communicate with BH providers.

This remote role requires work within the Eastern or Central Time Zone, BCBA certification, and licensure appropriate to state requirements.

Qualifications

• Requires graduate of an accredited school of nursing or bachelor’s degree with 2–4 years of related experience.
• BCBA license to practice independently or state licensure as outlined by the applicable 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 BH to determine medical appropriateness per ABA guidelines.
• Analyzes BH member data to improve quality and utilization of services.
• Interacts with BH healthcare providers to discuss level of care and services.
• Provides education to members and families regarding ABA and BH utilization process.
• Implements process improvements and contributes to policy development.

Skills

Written communication

Verbal communication

Computer skills

Auditing

Education

Bachelor's degree

Master's degree

BCBA certification

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)
• RN (Registered Nurse) with state licensure and/or compact state licensure
• BCBA (Board Certified Behavior Analyst) certification for ABA-related positions

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.

Work schedule: Monday through Friday, from 8:00 AM to 5:00 PM EST / CST.

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 regarding 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.

License/Certification

• LCSW - Licensed 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
• Licensed Behavior Analyst (LBA) where required by state required

Pay Range

$27.02 - $48.55 per hour

Benefits

Centene offers a comprehensive benefits package including:

• 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.

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

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.