Utilization Review Clinician – ABA

This is a fully remote position, open to applicants in California, +3 more states.

📋 Description

• Conduct assessments of members’ care and health conditions for Applied Behavioral Analysis (ABA) services to ascertain medical suitability.

• Oversee the clinical effectiveness and efficiency of members’ care in accordance with ABA guidelines.

• Assess care and health conditions prior to, during, and following ABA services.

• Execute prior authorization evaluations related to behavioral health.

• Examine behavioral health member data to enhance the quality and use of services.

• Engage with behavioral health providers regarding the level of care and services offered.

• Inform members and families about ABA and the process of behavioral health utilization.

• Provide leadership insights on opportunities for care improvement, processes, and policies.

• Adhere to all policies and standards.

• Carry out other assigned responsibilities.

⛳️ Requirements

• Must live in the PST, MST, or CST time zone.

• Graduate from an Accredited School of Nursing or hold a Bachelor's degree with 2-4 years of relevant experience.

• For Enterprise Population Health, a minimum of 2 years providing ABA services as a BCBA is required.

• A license to practice independently and/or state-required licensure as mandated by the applicable state (BCBA) is necessary.

• A Master’s degree for behavioral health clinicians is essential.

• Required behavioral health clinical knowledge and capability to review and/or evaluate ABA Treatment Plans.

• Knowledge of ABA services and the behavioral health utilization review process is essential.

• Preferred experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services.

• LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or necessary RN/BCBA licensure as applicable.

• Licensed Behavior Analyst (LBA) is required where mandated by state law.

• Independent licensure with ABA experience and BCBA is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Opportunities for stock purchase plans.

• Tuition reimbursement available.

• Paid time off plus holidays.

• Flexible work arrangements with options for remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in the total compensation package.