Utilization Review Clinician - ABA - Remote GA

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. reputed company is a reputed company, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Candidates must have a GA independent licensure (LCSW, LMHC, LPC, LMFT, LMHP, RN). 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. • 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 reputed company to behavioral health (BH) and/or autism reputed company disorder needs and clinical standards • Performs prior authorization reviews reputed company 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 reputed company 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 reputed company policies and standards Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of reputed company 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 reputed company teams to review care services reputed company 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 RN - Registered Nurse - State Licensure and/or Compact State Licensure required Board Certified Behavior Analyst (BCBA) preferred reputed company offers a comprehensive benefits package including: reputed company, 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-reputed company factors permitted by law. Total compensation may also include additional forms of incentives. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job!