Centene Corporation
Utilization Review Clinician - ABA
Centene Corporation, Phoenix, Arizona, United States, 85003
Position Purpose
Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines.
This is a remote position however must reside in Arizona.
Responsibilities
Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards
Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria
Analyzes BH member data to improve quality and appropriate utilization of services
Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
Provides education to members and their families regrading ABA and BH utilization process
Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies
Performs 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
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) 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
Board Certified Behavior Analyst (BCBA) required
Licensed Behavior Analyst (LBA) where required by state required
Pay Range: $26.50 - $47.59 per hour
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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This is a remote position however must reside in Arizona.
Responsibilities
Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards
Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria
Analyzes BH member data to improve quality and appropriate utilization of services
Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
Provides education to members and their families regrading ABA and BH utilization process
Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies
Performs 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
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) 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
Board Certified Behavior Analyst (BCBA) required
Licensed Behavior Analyst (LBA) where required by state required
Pay Range: $26.50 - $47.59 per hour
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
#J-18808-Ljbffr