Clinician

• 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 according to ABA guidelines
• Evaluate care before, during, and after ABA services for medical appropriateness and clinical standards
• Perform BH prior authorization reviews using ABA regulatory guidelines and criteria
• Analyze behavioral health member data to improve quality and appropriate service utilization
• Interact with behavioral health providers regarding level of care and services for members receiving ABA services
• Educate members and families about ABA and the behavioral health utilization process
• Provide leadership feedback on care improvement opportunities, process improvements, and new processes or policies
• Comply with all policies and standards and perform other assigned duties

Utilization Review Clinician – ABA

• Perform clinical reviews and assess care related to mental health and substance abuse
• Monitor and determine whether levels of care and services are medically appropriate
• Evaluate member treatment before, during, and after services
• Perform prior authorization reviews in accordance with regulatory guidelines and criteria
• Perform concurrent reviews of behavioral health inpatient care, including treatment needs and discharge planning
• Analyze behavioral health member data to improve quality and utilization
• Educate providers, members, and families about the behavioral health utilization process
• Interact with behavioral health providers regarding levels of care and services
• Engage with medical directors and leadership to improve care quality and efficiency
• Formulate and present cases in staffing and integrated rounds
• Comply with all policies and standards
• Perform other duties as assigned

Clinician jobs in Louisiana

Utilization Review Clinician – ABA

Utilization Review Clinician – Behavioral Health