Utilization Review Clinician – ABA

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

📋 Description

• Conduct assessments of members' care and health status for Applied Behavioral Analysis services to evaluate medical necessity.

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

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

• Execute prior authorization evaluations related to behavioral health.

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

• Collaborate with behavioral health healthcare providers regarding the level of care and available services.

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

• Provide feedback on care improvement opportunities, procedural enhancements, and new processes or policies.

• Adhere to all policies and standards.

• Carry out additional duties as assigned.

⛳️ Requirements

• Candidates must reside in Florida.

• Current BCBA certification is mandatory.

• One of the following licenses or certifications is required: LCSW, LMHC, LPC, LMFT, LMHP, RN with state or compact state licensure, or BCBA.

• Must be a graduate of 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.

• Independent practice license and/or state-required licensure is essential.

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

• Strong behavioral health clinical knowledge and the ability to review and/or assess ABA Treatment Plans is necessary.

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

• LBA is required where mandated by state regulations.

• Experience collaborating with providers and healthcare teams to review care services related to ABA is preferred.

• Background in ABA treatment, proficiency in computer skills, excellent written and verbal communication abilities, as well as auditing and QA expertise is highly preferred.

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

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Competitive compensation.

• Additional incentives may be included in the total compensation package.

• Commitment to equal opportunity and diversity.