Utilization Review Clinician - ABA

Résumé du poste

The clinician performs utilization reviews for Applied Behavioral Analysis (ABA) services to ensure medical appropriateness and clinical effectiveness. They also analyze member data, interact with healthcare providers, and provide education to families regarding the utilization process.

Détails du poste

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 reside in PST, MST, or CST time zone. 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 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

Ce que vous ferez

The clinician performs utilization reviews for Applied Behavioral Analysis (ABA) services to ensure medical appropriateness and clinical effectiveness. They also analyze member data, interact with healthcare providers, and provide education to families regarding the utilization process.

Exigences

Requires a Bachelor's degree or graduate of an accredited nursing school, along with 2-4 years of related experience. Candidates must hold a relevant independent license such as LCSW, LMHC, LPC, LMFT, or BCBA.

Avantages

• Competitive pay • Health insurance • 401k • Stock purchase plans • Tuition reimbursement • Paid time off • Holidays • Flexible work schedules

Compétences indiquées

• Provider Relations · Souhaitée
• Analyse de données · Souhaitée
• case management · Souhaitée

Autres compétences pertinentes

Relevées dans la description du poste. Confirmez les exigences importantes ci-dessus.

• Utilization review
• Applied behavioral analysis
• Behavioral health
• Medical appropriateness
• Prior authorization
• Clinical standards
• Data analysis
• Provider relations
• Patient education
• Treatment plan assessment
• Case management
• Clinical documentation
• Board Certified Behavior Analyst (BCBA)
• Licensed Mental Health Counselor (LMHC)
• Time Off Management
• Treatment Planning
• Applied Behavior Analysis
• Autism Spectrum Disorders
• Family Therapy
• Leadership
• Licensed Clinical Social Worker (LCSW)
• Licensed Marriage And Family Therapist (LMFT)
• Licensed Mental Health Professional
• Licensed Professional Counselor (LPC)
• Nursing
• Population Health
• Utilization Management
• Process Improvement
• Behavioral Health

Domaines d’emploi

• Healthcare
• Social Services
• Utilization Review Clinician
• Clinical Auditor / Utilization Reviewer
• Health Service Managers
• Health Informatics Specialists
• Computer Systems Analysts