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 ascertain medical suitability.

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

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

• Carry out prior authorization evaluations related to behavioral health.

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

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

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

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

• Adhere to all policies and standards.

• Perform other assigned responsibilities.

⛳️ Requirements

• Candidates must reside in Florida.

• Active BCBA certification is mandatory.

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

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

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

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

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

• LBA certification is required by state where applicable.

• Experience in ABA treatment is preferred.

• Proficiency with computers is preferred.

• Strong written and verbal communication skills are preferred.

• Experience with auditing and quality assurance is highly preferred.

• Experience collaborating with providers and healthcare teams in reviewing ABA services is preferred.

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

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Additional incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.