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Utilization Review Clinician – Aba
| Company | Centene |
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| Location | Tampa, FL, USA |
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| Salary | $26.5 – $47.59 |
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| Type | Full-Time |
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| Degrees | Bachelor’s, Master’s |
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| Experience Level | Mid Level |
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Requirements
- Graduate of an Accredited School Nursing or Bachelor’s degree and 2 – 4 years of related experience
- License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required
- Master’s degree for behavioral health clinicians required
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
Preferred Qualifications
- Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans preferred
- Knowledge of ABA services and BH utilization review process preferred
- Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred
- Board Certified Behavior Analyst (BCBA) preferred
