Licensed Utilization Review Clinician
Job Summary
To ensure the medical appropriateness of Applied Behavioral Analysis (ABA) services, the full-time Licensed Utilization Review Clinician will perform reviews of member care and health status remotely, while working within the Eastern or Central Time Zone.
Key responsibilities
- Evaluates member care and health status related to ABA services to ensure compliance with clinical standards
- Performs prior authorization reviews to determine medical appropriateness in accordance with ABA regulatory guidelines
- Analyzes behavioral health member data to enhance service quality and utilization
Required qualifications
- Active BCBA certification and one of the following: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state licensure
- Master's degree for behavioral health clinicians required
- 2-4 years of related experience in ABA services or behavioral health
- Knowledge of ABA services and behavioral health utilization review processes
- Experience working with healthcare providers to review ABA care services preferred
Complete Job Description
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