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 (ABA) services to ascertain medical necessity.

• Oversee the clinical efficacy and efficiency of members' care in alignment with ABA standards.

• Assess care and health status prior to, during, and after ABA services to ensure the appropriate level of care and the services provided.

• Execute prior authorization evaluations related to behavioral health (BH).

• Examine BH member data to enhance quality and suitable utilization of services.

• Collaborate with BH healthcare providers regarding the level of care and services for members undergoing ABA services.

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

• Offer leadership insights on opportunities for care-service enhancements, process improvements, and the creation of new procedures or policies.

• Adhere to all policies and standards.

• Carry out additional tasks as assigned.

⛳️ Requirements

• Graduate from an accredited School of Nursing or possess 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.

• Must possess a license to practice independently and/or meet state-required licensure as specified by applicable state regulations (BCBA).

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

• Comprehensive knowledge of behavioral health clinical practices and the ability to review and/or evaluate ABA Treatment Plans is essential.

• Familiarity with ABA services and the BH utilization review process is necessary.

• BCBA certification is mandatory.

• Licensure/certification such as LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or LBA, as applicable, is required.

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

• Independent licensure with ABA experience and BCBA is preferred.

• Experience in ABA treatment is preferred.

• Technological proficiency is desirable.

• Experience in managed care is preferred.

• Previous collaboration with providers and healthcare teams to assess care services related to Applied Behavior Analysis Services is preferred.

• Ability to adapt in a fast-paced environment.

• Exceptional customer service, communication, and organizational skills are essential.

• Availability to work Monday through Friday, from 8:00 AM to 5:00 PM.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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

• Competitive compensation.

• Additional incentives may be included in total compensation.