Position Overview

Centene is actively seeking a Utilization Review Clinician – ABA to conduct prior authorization reviews for Applied Behavior Analysis (ABA) treatment services. This role requires evaluating clinical documentation for medical necessity and ensuring adherence to established clinical guidelines and health plan policies.

Schedule

Monday–Friday, 8:00 AM–5:00 PM (Remote)

Preferred Qualifications

• Experience with ABA treatment and clinical documentation review
• Strong knowledge of medical necessity criteria and utilization management principles
• Prior authorization and managed care experience
• Proficiency in reviewing ABA treatment plans and progress reports

Position Purpose

The clinician will perform reviews of members' care and health status for ABA services to determine medical appropriateness and monitor clinical effectiveness in accordance with ABA guidelines.

• Evaluate member’s care throughout the ABA service delivery process
• Conduct prior authorization reviews to ensure medical appropriateness
• Analyze member data to enhance service quality
• Engage with BH healthcare providers regarding member care
• Educate members and families on ABA and BH processes
• Provide feedback for care service improvement
• Adhere to all relevant policies and standards

Education and Experience

A Graduate of an Accredited School of Nursing or a Bachelor's degree with 2-4 years of relevant experience is required. Additionally, for Enterprise Population Health, 2+ years in providing ABA services as a BCBA is necessary.

Licenses and Certifications

• LCSW, LMHC, LPC, LMFT, LMHP, BCBA, RN, or LBA licensure is required based on state requirements

Benefits

Centene offers a comprehensive benefits package, including competitive pay, health insurance, retirement plans, tuition reimbursement, and flexible work options, ensuring a rewarding employment experience.

Diversity and Equal Opportunity

Centene is committed to diversity and values varied perspectives, encouraging all qualified candidates to apply regardless of their background.