利用审查临床医生 - ABA
Utilization Review Clinician - ABA
职位职责：对接受应用行为分析（ABA）服务的会员的护理和健康状况进行评估，以确定医疗服务的医学适当性。根据ABA指南监控会员护理的临床效果和效率。
关键信息：这是一个远程职位；但申请人必须能够在东部或中部时区工作。候选人必须持有有效的BCBA认证，并且具备以下之一的必要执照或证书：LCSW（临床社会工作者）、LMHC（心理健康咨询师）、LPC（专业咨询师）、LMFT（婚姻与家庭治疗师）、LMHP（心理健康专业人士）或RN（注册护士）并具有州执照和/或紧凑州执照。对于与ABA相关的职位，候选人也可以通过BCBA（行为分析师认证委员会认证）认证来满足条件。
具有ABA治疗经验、良好的计算机技能、出色的书面和口头沟通能力以及审计和质量保证（QA）经验的候选人将被优先考虑。工作时间是周一至周五，上午8点至下午5点（EST/CST）。
- 在提供应用行为分析（ABA）服务之前、期间和之后评估会员的护理和健康状况，以确保护理水平和服务在行为健康（BH）和/或自闭症谱系障碍需求及临床标准方面是医学适当的
- 根据ABA监管指南和标准，对行为健康相关的事前授权审查，以确定医学适当性
- 分析行为健康会员数据，以提高服务质量和适当使用率
- 与行为健康医疗保健提供者进行适当交流，讨论为接受应用行为分析服务的会员提供的护理水平和服务
- 向会员及其家庭提供有关ABA和行为健康使用流程的教育
- 向管理层提供反馈，提出通过流程改进和新流程和/或政策开发来改善护理服务的机会
- 执行其他指派的任务
- 遵守所有政策和标准
教育/经验：要求毕业于经认证的护理学校或获得学士学位，并有2-4年相关经验。
对于企业人群健康部门，需要2年以上作为BCBA提供ABA服务的经验。
具备独立执业的执照，或已获得州规定的执照。
查看英文原文
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.
Key Details: This is a remote position; however, applicants must be able to work within the Eastern or Central Time Zone. Candidates must hold an active BCBA certification, and one of the following required licenses or certifications: LCSW (Licensed Clinical Social Worker), LMHC (Licensed Mental Health Counselor), LPC (Licensed Professional Counselor), LMFT (Licensed Marital and Family Therapist), LMHP (Licensed Mental Health Professional), or RN (Registered Nurse) with state licensure and/or compact state licensure. For ABA-related positions, candidates may also qualify with a BCBA (Board Certified Behavior Analyst) certification.
Candidates with experience in ABA treatment, strong computer skills, excellent written and verbal communication skills, and experience with auditing and quality assurance (QA) are highly preferred. The work schedule is Monday through Friday, from 8:00 AM to 5:00 PM EST / CST.
- 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.
Master’s degree for behavioral health clinicians 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:
- LCSW- License Clinical Social Worker required or
- LMHC-Licensed Mental Health Counselor required or
- LPC-Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- Board Certified Behavior Analyst (BCBA) required
- RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or
- Independent licensure with ABA experience and BCBA preferred. preferred
- Licensed Behavior Analyst (LBA) where required by state required
Pay Range: $27.02 - $48.55 per hour
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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
Originally posted on Himalayas