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Utilization Review Clinician – ABA
Centene Corporation. Perform reviews of members’ care and health status for Applied Behavioral Analysis services to determine medical appropriateness .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Applied Behavioral Analysis (ABA) services, including the ability to evaluate care and health status, perform prior authorization reviews, and analyze behavioral health data. Holds relevant licensure and possesses strong clinical knowledge to improve service quality and utilization.
Highest-signal resume keywords
BCBA CertificationBehavioral Health Clinical KnowledgePrior Authorization Review ExperienceLCSW, LMHC, LPC, LMFT, LMHP CertificationExperience with ABA Treatment Plans
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Applied Behavioral Analysis ServicesBehavioral Health Utilization ReviewCare EvaluationData AnalysisClinical Effectiveness Monitoring
Soft Skills
Leadership FeedbackInterpersonal CommunicationPatient Education
Certifications & Qualifications
Licensed Behavior Analyst (LBA)RN State LicensureIndependent Licensure
Industry Keywords
Behavioral HealthHealthcare ProvidersCare Improvement ProcessesClinical PoliciesMember Care Monitoring
About the role
Key responsibilities & impact- Perform reviews of members’ care and health status for Applied Behavioral Analysis services to determine medical appropriateness
- Monitor clinical effectiveness and efficiency of member care in accordance with ABA guidelines
- Evaluate care and health status before, during, and after ABA services
- Perform prior authorization reviews related to behavioral health
- Analyze behavioral health member data to improve quality and appropriate utilization of services
- Interact with behavioral health healthcare providers regarding level of care and services
- Educate members and families about ABA and the behavioral health utilization process
- Provide leadership feedback on care improvement opportunities, processes, and policies
- Comply with all policies and standards
- Perform other assigned duties
Requirements
What you’ll need- 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 state-required licensure as applicable (BCBA)
- Master’s degree for behavioral health clinicians required
- Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans
- Knowledge of ABA services and BH utilization review process
- LCSW, LMHC, LPC, LMFT, LMHP, or BCBA required
- RN state licensure and/or compact state licensure with BCBA required for RN pathway
- Licensed Behavior Analyst (LBA) where required by state
- Independent licensure with ABA experience and BCBA preferred
- Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred
- Ability to work Monday through Friday, 8:00 am to 5:00 pm Eastern Time, with occasional weekends and holidays
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity and diversity commitment