Utilization Review Clinician - ABA

Centene Corp.; Town of Florida (NY); Hybrid; USD 37,000 - 66,000; Full time

Benefits offered by this job

Remote work

Flexible work arrangements

Job summary

Centene Corp. seeks an Utilization Review Clinician – ABA for a fully remote role with Florida residency preferred. You will evaluate member care, perform prior authorization reviews, and collaborate with BH providers to ensure medically appropriate ABA services.

Requirements include a nursing degree or bachelor’s with 2–4 years ABA/BH experience; BCBA licensure is preferred and a master’s in behavioral health is required for clinicians. Schedule is M-F 8–5 ET with occasional weekends.

Qualifications

• Graduate of an Accredited School of Nursing or Bachelor's degree with 2–4 years of related experience; BCBA experience preferred.
• Master’s degree in behavioral health required for clinicians; strong ABA knowledge and BH utilization review skills.
• Licensure: BCBA or equivalent state licensure; RN licensure and/or BCBA preferred.

Responsibilities

• Evaluate member care and health status before, during, and after ABA services to ensure medical appropriateness.
• Perform prior authorization reviews related to BH to determine medical necessity per ABA guidelines.
• Analyze BH member data to improve quality and utilization of ABA services.
• Interact with BH healthcare providers to discuss level of care and services.
• Provide education to members and families regarding ABA and BH utilization process.
• Give feedback to leadership on process improvements and policy development.

Skills

ABA knowledge

Utilization review

Prior authorization

Provider collaboration

Education

Bachelor's degree in nursing or related field

Master's degree in behavioral health

BCBA certification

Tools

BCBA

Job description

## Utilization Review Clinician - ABAApply: Remote-FL: Full time: Posted Today: 1663977**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 fully remote role. Preference will be given to applicants who reside in Florida. The schedule is Monday through Friday 8:00 am to 5:00 pm eastern time with occasional weekends and holidays. * 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 requiredPay Range: $27.02 - $48.55 per hour **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.