Centene Corporation • Remote • Posted 4 days ago
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The Utilization Review Clinician performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services to determine medical appropriateness. This role involves monitoring clinical effectiveness and efficiency of member's care in accordance with ABA guidelines, evaluating member’s care and health status, performing prior authorization reviews related to behavioral health, analyzing member data to improve quality and utilization of services, and providing education to members and their families regarding ABA and behavioral health utilization process.
About Centene Corporation
Centene Corporation is a leading healthcare enterprise in the United States, specializing in managed healthcare products and services primarily through Medicaid, Medicare, and commercial products. They offer healthcare coverage through managed care plans that include medical, behavioral, and specialty services, aiming to improve health outcomes for underserved populations. Operating on a global scale, Centene has a significant presence in over 30 states and continues to grow through strategic expansions and partnerships, such as acquiring WellCare Health Plans in 2020.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
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.
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Master’s degree for behavioral health clinicians required.
Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans preferred.
Knowledge of ABA services and BH utilization review process preferred.
Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred.
License/Certification:
Pay Range: $25.97 - $46.68 per hour
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. Total compensation may also include additional forms of incentives.
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
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