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 evaluate member care and health status, perform prior authorization reviews, and analyze behavioral health data, all while working remotely from specific time zones.
Key responsibilities
- Evaluates member care and health status related to ABA services to ensure medical appropriateness
- Performs prior authorization reviews for behavioral health services in accordance with ABA guidelines
- Analyzes behavioral health data to enhance service quality and utilization
Required qualifications
- Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience
- Master's degree required for behavioral health clinicians
- Licensed Clinical Social Worker (LCSW), Licensed Mental Health Counselor (LMHC), or similar licensure required
- Behavioral health clinical knowledge and experience with ABA Treatment Plans required
- Board Certified Behavior Analyst (BCBA) certification preferred
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