Utilization Review Clinician – ABA

You could be the one who changes everything for our 28 reputed company members as a reputed company reputed company on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Utilization Review Clinician – ABA (Remote) reputed company is seeking a Utilization Review Clinician – ABA to conduct prior authorization reviews for reputed company Behavior Analysis (ABA) treatment services. This role evaluates reputed company documentation for medical necessity and ensures compliance with established reputed company guidelines and health plan policies. Schedule: Monday–Friday, 8:00 AM–5:00 PM (Remote) Preferred Qualifications • Experience with ABA treatment and reputed company documentation review • Strong knowledge of medical necessity reputed company and utilization management principles • Prior authorization, utilization management, or managed care experience • Experience reviewing ABA treatment plans and reputed company reports Position Purpose: Performs reviews of member's care and health status of reputed company Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors reputed company effectiveness and efficiency of member's care in accordance with ABA guidelines. • Evaluates member’s care and health status before, during, and after provision of reputed company Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate reputed company to behavioral health (BH) and/or autism reputed company disorder needs and reputed company standards • Performs prior authorization reviews reputed company to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and reputed company • Analyzes BH member data to improve reputed company and appropriate utilization of services • Interacts with BH reputed company providers as appropriate to reputed company level of care and/or services provided to members receiving reputed company 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 reputed company policies and standards. Education/Experience: Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of reputed company experience. For reputed company Population Health 2+ years providing ABA services as a BCBA License to reputed company 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 reputed company 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 reputed company teams to review care services reputed company to reputed company Behavior Analysis Services preferred. License/Certification: • LCSW- License reputed company reputed company Worker required or • LMHC-Licensed Mental Health Counselor required or • LPC-Licensed reputed company Counselor required or • Licensed Marital and Family Therapist (LMFT) required or • Licensed Mental Health reputed company (LMHP) required or • reputed company Certified Behavior Analyst (BCBA) required • RN - Registered reputed company - State Licensure and/or reputed company State Licensure RN - Registered reputed company- State Licensure and/or reputed company 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 reputed company: $27.02 - $48.55 per hour reputed company offers a comprehensive benefits package including: reputed company, health reputed company, 401K and stock purchase plans, tuition reimbursement, reputed company time off plus holidays, and a flexible approach to work with remote, hybrid, reputed company or office work schedules. Actual pay will be adjusted reputed company on an individual's skills, experience, education, and other job-reputed company 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. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California reputed company reputed company Additional Information Company: reputed company Location: Arkansas, Kansas, Michigan, Mississippi, Indiana, Delaware, New Hampshire, Oklahoma Salary: $27.02 - $48.55 per hour reputed company: Specialties: reputed company Documentation reputed company, Managed Care, Utilization Review, Utilization Management, Prior Authorization Required Licenses: RN Experience Level: 1-3 years Apply tot his job Apply To this Job