Utilization Review Clinician – ABA

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

📋 Description

• Conduct assessments of members' care and health conditions for Applied Behavioral Analysis services to assess medical suitability.

• Oversee the clinical effectiveness and efficiency of member care in line with ABA standards.

• Review care and health status prior to, during, and following ABA services.

• Execute prior authorization evaluations related to behavioral health.

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

• Communicate with behavioral health healthcare providers regarding the level of care and services provided.

• Educate members and their families about ABA and the behavioral health utilization procedures.

• Offer leadership insights on opportunities for care improvements, processes, and policies.

• Adhere to all relevant policies and standards.

• Carry out additional assigned responsibilities.

⛳️ Requirements

• Graduate from an accredited nursing school or possess a Bachelor's degree with 2-4 years of relevant experience.

• For Enterprise Population Health: Minimum of 2 years providing ABA services as a BCBA.

• License to practice independently and/or state-required licensure as applicable (BCBA).

• Master's degree in behavioral health for clinicians is mandatory.

• Knowledge of behavioral health clinical practices and the ability to review and/or evaluate ABA Treatment Plans.

• Understanding of ABA services and the behavioral health utilization review process.

• LCSW, LMHC, LPC, LMFT, LMHP, or BCBA credentials are required.

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

• Licensed Behavior Analyst (LBA) as mandated by state regulations.

• Independent licensure with ABA experience and BCBA preferred.

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

• Availability to work Monday through Friday, from 8:00 am to 5:00 pm Eastern Time, with occasional weekends and holidays.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off.

• Paid holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.

• Additional incentive options may be included in overall compensation.

• Commitment to equal opportunity and diversity.