Centene

2 days ago

Utilization Review Clinician - ABA

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 15 hours agoStatus: Live

Job Summary

Conduct utilization review for Applied Behavioral Analysis (ABA) services to determine medical appropriateness for behavioral health and autism spectrum disorder needs. Evaluate care before, during, and after ABA services, perform prior authorization reviews, analyze member data to improve quality and utilization, collaborate with behavioral health providers, and educate members and families. Provide feedback to leadership on process improvements and maintain compliance with ABA and regulatory guidelines.

Location: Florida

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Evaluate a member’s care and health status before, during, and after ABA services to ensure medical appropriateness for behavioral health and autism spectrum disorder needs.
•Perform prior authorization reviews related to behavioral health to determine medical appropriateness per ABA regulatory guidelines and criteria.
•Analyze behavioral health member data to improve quality and appropriate utilization of services.
•Coordinate with behavioral health providers to discuss the level of care and services provided to members receiving ABA services.
•Educate members and their families on the ABA and behavioral health utilization process and provide feedback to leadership on process improvement opportunities.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly

Perks:Health Insurance401kEquityPaid Leave

Key Requirements

•Master’s degree for behavioral health clinicians, plus behavioral health clinical knowledge to review and/or assess ABA treatment plans.
•2–4 years of related experience (or 2+ years providing ABA services as a BCBA, for Enterprise Population Health).
•License/certification to practice independently as required by the applicable state, including options such as BCBA, LCSW, LMHC, LPC, LMFT, LMHP, RN (state/compact), or LBA (where required).
•Knowledge of ABA services and the behavioral health utilization review process.
•Excellent written and oral communication skills, with experience working with providers and healthcare teams (preferred).

Experience:2-4 years

Education:Master's

Skills:Excellent written communicationExcellent oral communicationProcess improvementAnalyzing dataEducating others

Licenses:LCSWLMHCLPCLMFTLMHPBCBARNLBA

Certifications:BCBA Certificate

Company Brief

Centene

Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn

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Centene

2 days ago

Utilization Review Clinician - ABA

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 15 hours agoStatus: Live

Job Summary

Location: Florida

Workplace: Remote

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Evaluate a member’s care and health status before, during, and after ABA services to ensure medical appropriateness for behavioral health and autism spectrum disorder needs.
•Perform prior authorization reviews related to behavioral health to determine medical appropriateness per ABA regulatory guidelines and criteria.
•Analyze behavioral health member data to improve quality and appropriate utilization of services.
•Coordinate with behavioral health providers to discuss the level of care and services provided to members receiving ABA services.
•Educate members and their families on the ABA and behavioral health utilization process and provide feedback to leadership on process improvement opportunities.

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly

Perks:Health Insurance401kEquityPaid Leave

Key Requirements

•Master’s degree for behavioral health clinicians, plus behavioral health clinical knowledge to review and/or assess ABA treatment plans.
•2–4 years of related experience (or 2+ years providing ABA services as a BCBA, for Enterprise Population Health).
•License/certification to practice independently as required by the applicable state, including options such as BCBA, LCSW, LMHC, LPC, LMFT, LMHP, RN (state/compact), or LBA (where required).
•Knowledge of ABA services and the behavioral health utilization review process.
•Excellent written and oral communication skills, with experience working with providers and healthcare teams (preferred).

Experience:2-4 years

Education:Master's

Skills:Excellent written communicationExcellent oral communicationProcess improvementAnalyzing dataEducating others

Licenses:LCSWLMHCLPCLMFTLMHPBCBARNLBA

Certifications:BCBA Certificate

Company Brief

Centene

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn