Utilization Review Clinician – ABA

This is a fully remote position, open to applicants in Florida.

📋 Description

• Evaluate the care and health status of members before, during, and after the provision of ABA services.

• Assess the medical appropriateness, level of care, and service requirements in line with ABA guidelines and clinical standards.

• Conduct prior authorization reviews pertaining to behavioral health.

• Examine behavioral health member data to enhance service quality and appropriate utilization.

• Collaborate with behavioral health providers regarding the level of care and services for members engaged in ABA.

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

• Offer leadership insights on opportunities for care improvement, process enhancements, and the introduction of new processes or policies.

• Adhere to all policies and standards.

• Undertake other assigned responsibilities.

⛳️ Requirements

• Candidates must be residents of Florida.

• BCBA certification is mandatory.

• Experience in ABA treatment is essential.

• Proficiency in technology is preferred.

• Strong customer service and communication skills are preferred.

• Work schedule is Monday through Friday, from 8:00 AM to 5:00 PM.

• Must be a graduate from an Accredited School of Nursing or hold a Bachelor's degree with 2–4 years of relevant experience.

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

• Independent practice license and/or state-required licensure (BCBA) is necessary.

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

• Clinical knowledge in behavioral health and the ability to review and/or evaluate ABA Treatment Plans is required.

• Familiarity with ABA services and the behavioral health utilization review process is mandatory.

• Experience collaborating with providers and healthcare teams to assess care services related to Applied Behavior Analysis is preferred.

• One of the following credentials is required: LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or LBA as mandated by state regulations.

• RN state licensure and/or compact state licensure alongside BCBA certification is required for the RN pathway.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Potential additional incentives as part of the overall compensation package.