Arizona Complete Health
Position Purpose
Performs reviews of member care and health status for Applied Behavior Analysis (ABA) services to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member care in accordance with ABA guidelines. This is a remote position; applicants must reside in Arizona. Responsibilities
Evaluate member care and health status before, during, and after ABA services to ensure medical appropriateness related to behavioral health and autism spectrum disorder needs. Perform prior authorization reviews related to behavioral health to determine medical appropriateness in accordance with ABA regulatory guidelines. Analyze behavioral health member data to improve quality and appropriate utilization of services. Interact with behavioral health healthcare providers as appropriate to discuss level of care and services provided to members receiving ABA services. Provide education to members and families regarding ABA and behavioral health utilization process. Provide feedback to leadership on opportunities to improve care services through process improvement and development of new processes and/or policies. Perform other duties as assigned. Qualifications
Education / Experience
Graduate of an accredited school of nursing or bachelor’s degree with 2-4 years of related experience. Enterprise Population Health: 2+ years providing ABA services as a BCBA. License / Certification
Board Certified Behavior Analyst (BCBA) required. Licensed Behavior Analyst (LBA) required where state mandate applies. License to practice independently or state-required licensure as outlined for BCBA required. Behavioral health clinical knowledge and ability to review and assess ABA treatment plans required. Knowledge of ABA services and behavioral health utilization review process required. Experience working with providers and healthcare teams to review care services related to ABA services preferred. Pay / Benefits
Pay Range: $26.50 - $47.59 per hour. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. EEO Statement
Centene is an equal opportunity employer committed to diversity and values differences. 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 protected characteristics. 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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Performs reviews of member care and health status for Applied Behavior Analysis (ABA) services to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member care in accordance with ABA guidelines. This is a remote position; applicants must reside in Arizona. Responsibilities
Evaluate member care and health status before, during, and after ABA services to ensure medical appropriateness related to behavioral health and autism spectrum disorder needs. Perform prior authorization reviews related to behavioral health to determine medical appropriateness in accordance with ABA regulatory guidelines. Analyze behavioral health member data to improve quality and appropriate utilization of services. Interact with behavioral health healthcare providers as appropriate to discuss level of care and services provided to members receiving ABA services. Provide education to members and families regarding ABA and behavioral health utilization process. Provide feedback to leadership on opportunities to improve care services through process improvement and development of new processes and/or policies. Perform other duties as assigned. Qualifications
Education / Experience
Graduate of an accredited school of nursing or bachelor’s degree with 2-4 years of related experience. Enterprise Population Health: 2+ years providing ABA services as a BCBA. License / Certification
Board Certified Behavior Analyst (BCBA) required. Licensed Behavior Analyst (LBA) required where state mandate applies. License to practice independently or state-required licensure as outlined for BCBA required. Behavioral health clinical knowledge and ability to review and assess ABA treatment plans required. Knowledge of ABA services and behavioral health utilization review process required. Experience working with providers and healthcare teams to review care services related to ABA services preferred. Pay / Benefits
Pay Range: $26.50 - $47.59 per hour. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules. EEO Statement
Centene is an equal opportunity employer committed to diversity and values differences. 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 protected characteristics. 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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