Utilization Review Clinician - ABA

Utilization Review Clinician - ABA

• The job posting describes a remote position with requirements to work within the Eastern or Central Time Zone. Candidates must hold an active BCBA certification, and one of the following required licenses or certifications: LCSW (Licensed Clinical Social Worker), LMHC (Licensed Mental Health Counselor), LPC (Licensed Professional Counselor), LMFT (Licensed Marital and Family Therapist), LMHP (Licensed Mental Health Professional), or RN (Registered Nurse) with state licensure and/or compact state licensure. For ABA-related positions, candidates may also qualify with a BCBA (Board Certified Behavior Analyst) certification.

• Responsibilities include evaluating member’s care and health status before, during, and after provision of ABA services to ensure medical appropriateness related to BH and/or autism spectrum disorder needs and clinical standards; performing prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria; analyzing BH member data to improve quality and appropriate utilization of services; interacting with BH healthcare providers to discuss level of care and/or services; providing education to members and their families regrading ABA and BH utilization process; providing feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies; and performing other duties as assigned. Complies with all policies and standards.

• Education/Experience: Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience. For Enterprise Population Health 2+ years providing ABA services as a BCBA. Licensure to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required. Master’s degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.

• License/Certification:

• LCSW- License Clinical Social Worker required or

• LMHC-Licensed Mental Health Counselor required or

• LPC-Licensed Professional Counselor required or

• Licensed Marital and Family Therapist (LMFT) required or

• Licensed Mental Health Professional (LMHP) required or

• Board Certified Behavior Analyst (BCBA) required

• RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or

• Independent licensure with ABA experience and BCBA preferred. preferred

• Licensed Behavior Analyst (LBA) where required by state required

• Pay Range: $27.02 - $48.55 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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