Utilization Review Clinician – ABA

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

📋 Description

• Conduct assessments of members’ care and health status for Applied Behavioral Analysis services to ascertain medical appropriateness.

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

• Assess care before, during, and after ABA services for medical appropriateness and adherence to clinical standards.

• Execute behavioral health prior authorization reviews utilizing ABA regulatory guidelines and criteria.

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

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

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

• Offer leadership insights on opportunities for care improvement, process enhancements, and new procedures or policies.

• Adhere to all policies and standards while performing other assigned responsibilities.

⛳️ Requirements

• Must possess a license in Louisiana or Georgia.

• Graduate from an Accredited School of Nursing or hold a Bachelor's degree with 2-4 years of related experience.

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

• Required to have a license to practice independently and/or state-required licensure (BCBA) as applicable.

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

• Must have behavioral health clinical knowledge and the capability to review and/or assess ABA Treatment Plans.

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

• State/compact licensure including LCSW, LMHC, LPC, LMFT, LMHP, BCBA, RN with BCBA, or LBA as required by state.

• Experience collaborating with providers and healthcare teams in reviewing Applied Behavior Analysis services is preferred.

• BCBA with ABA treatment experience is highly preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

• Additional incentive programs may be included in total compensation.