Utilization Review Clinician – ABA

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

📋 Description

• Conduct assessments of members' care and health status for Applied Behavioral Analysis (ABA) services to establish medical appropriateness.

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

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

• Execute behavioral health prior authorization reviews aligned with ABA regulatory standards and criteria.

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

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

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

• Provide constructive feedback on care-service enhancement opportunities, process improvements, and the development of new processes or policies.

• Adhere to all relevant policies and standards.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Candidates must be able to operate within the Eastern or Central Time Zone.

• Current BCBA certification is required.

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

• For positions related to ABA, BCBA certification may be sufficient.

• Prior experience in ABA treatment is strongly preferred.

• Proficient computer skills are highly preferred.

• Excellent written and verbal communication skills are highly preferred.

• Experience in auditing and quality assurance (QA) is highly preferred.

• Graduation from an Accredited School of Nursing or a Bachelor's degree with 2-4 years of relevant experience is required.

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

• Independent practice license and/or applicable state licensure is mandatory.

• 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 required.

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

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

• LCSW, LMHC, LPC, LMFT, LMHP, BCBA, or RN state/compact state licensure with BCBA is required as applicable.

• Licensed Behavior Analyst (LBA) is required where mandated by state law.

• Independent licensure with ABA experience and BCBA is preferred.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

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