Florida Licensed Utilization Review Clinician
Job Summary
To ensure the medical appropriateness of Applied Behavioral Analysis (ABA) services, the full-time Florida Licensed Utilization Review Clinician will perform care reviews, prior authorization assessments, and data analysis while working remotely from Florida.
Key responsibilities
- Evaluates member care and health status related to ABA services to ensure medical appropriateness
- Performs prior authorization reviews in accordance with ABA regulatory guidelines
- Analyzes behavioral health member data to enhance service quality and utilization
Required qualifications
- Graduate of an accredited nursing school or Bachelor's degree with 2-4 years of related experience
- BCBA certification and 2+ years of providing ABA services required
- Master's degree for behavioral health clinicians required
- Knowledge of ABA services and behavioral health utilization review processes required
- Licensure as a Clinical Social Worker, Licensed Mental Health Counselor, Licensed Professional Counselor, or equivalent required
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