Utilization Review Clinician- ABA

1 month ago

Tallahassee, United States Centene Corporation Full time

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 IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF FLORIDA**** *******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 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 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:**+ 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) preferredPay Range: $25.97 - $46.68 per hourCentene 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

  • Clinical Utilization Specialist

    7 days ago

    Tallahassee, United States Centene Corporation Full time

    Job SummaryThe ideal candidate will have strong clinical knowledge and experience in behavioral health, with a focus on ABA services. You will be responsible for conducting thorough reviews of treatment plans, assessing their medical appropriateness, and identifying opportunities for improvement.In this role, you will work closely with healthcare providers...

  • Mental Health Clinician Opportunity in Charlottesville, VA

    3 weeks ago

    Tallahassee, Florida, United States Thriveworks Full time

    Thriveworks is a clinician-founded national private practice group with locations across the United States. Our mission is to provide accessible, high-quality mental health services to individuals and families. We are seeking licensed clinicians to join our team in Charlottesville, Virginia.We offer a competitive salary of up to $126,700 per year, depending...

  • Certified ABA Technician

    4 months ago

    Tallahassee, United States Hopebridge Full time

    Why Youll Love this Registered Behavior Technician Job! Are you driven by a passion to create a meaningful impact on a child's life, with far-reaching effects that transformfamilies and the community? Embark on a rewarding career as a Registered Behavior Technician (RBT) with Hopebridge in Tallahassee, FL, where every day is a new opportunity to make a...

  • Per Diem Cardiac Anesthesiology Opportunity in Florida

    2 weeks ago

    Tallahassee, Florida, United States DRW Healthcare Staffing Full time

    DRW Healthcare Staffing is seeking a skilled Cardiac Anesthesiologist to provide coverage in the Treasure Coast area of Florida. This per diem opportunity offers flexibility and variety, making it an attractive choice for professionals looking for a fulfilling work experience.The ideal candidate will be ABA/AOA Board Certified with a Cardiac Fellowship & TEE...

  • Administrative Support Specialist

    3 days ago

    Tallahassee, United States KEPRO Full time

    About the JobWe are seeking a skilled and detail-oriented Administrative Assistant to join our team at KEPRO. As a key member of our organization, you will play a vital role in the management of our claims tracking system.Your primary responsibility will be to input new claims with meticulous attention to demographic data, provider information, and other...

  • Practice Extend Clinical Pharmacist

    4 days ago

    Tallahassee, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

  • Physical Therapist PT Home Health

    1 month ago

    Tallahassee, United States PruittHealth Full time

    Physical Therapist PT – Home Health Services Special consideration for applicants who currently live in or commutable to Leon County, Florida Home is where the heart is!  That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. ...

  • Cardiac Cath Lab Nurse

    3 weeks ago

    Tallahassee, Florida, United States TotalMed Staffing Full time

    Are you a skilled Cardiac Cath Lab nurse looking for a travel opportunity in the Southeast? IDR Healthcare is seeking a dedicated and compassionate RN to join their team in Tallahassee, Florida. About IDR HealthcareIDR Healthcare is an award-winning staffing firm that prioritizes providing exceptional care to healthcare professionals. Our mission is to...

  • Travel Nurse RN

    1 week ago

    Tallahassee, United States HealthTrust Workforce Solutions HCA Full time

    Job OverviewHealthTrust Workforce Solutions HCA is seeking a travel nurse to provide expert care in Telemetry for a 13-week assignment in Florida.About the RoleThis opportunity offers a chance to work with a leading healthcare provider, utilizing your skills and experience to deliver exceptional patient experiences.The ideal candidate will have strong...

  • RN Home Health Salaried

    2 weeks ago

    Tallahassee, United States PruittHealth Full time

    Registered Nurse RN - Home Health Services Special consideration for applicants who currently live in or commutable to (Leon) County, (FL) Home is where the heart is! That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. New...

  • Physical Therapist PT Home Health

    1 month ago

    Tallahassee, United States PruittHealth Full time

    Physical Therapist PT – Home Health Services Special consideration for applicants who currently live in or commutable to Leon County, Florida Home is where the heart is! That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. New...

  • Physical Therapist PT Home Health

    2 weeks ago

    Tallahassee, United States SimplyApply Full time

    Physical Therapist PT - Home Health Services Special consideration for applicants who currently live in or commutable to Leon County, Florida Home is where the heart is! That's why is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. New Pay Per Point...

  • Physical Therapist PT Home Health

    1 month ago

    Tallahassee, United States PruittHealth Full time

    Physical Therapist PT – Home Health Services Special consideration for applicants who currently live in or commutable to Leon County, Florida Home is where the heart is!  That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. ...

  • Physical Therapist PT Home Health

    4 weeks ago

    Tallahassee, United States PruittHealth Full time

    Physical Therapist PT – Home Health Services Special consideration for applicants who currently live in or commutable to Leon County, Florida Home is where the heart is!  That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. ...

  • Physical Therapist PT Home Health

    1 month ago

    Tallahassee, United States PruittHealth Full time

    Physical Therapist PT – Home Health Services Special consideration for applicants who currently live in or commutable to Leon County, Florida Home is where the heart is!  That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. ...

  • RN Home Health Salaried

    5 days ago

    Tallahassee, United States PruittHealth Full time

    Registered Nurse RN – Home Health Services Special consideration for applicants who currently live in or commutable to (Leon) County, (FL) Home is where the heart is! That's why PruittHealth @ Home is committed to caring for our patients and residents, as well as providing our employees with a rewarding career as a member of our PruittHealth family. New...

  • Medical Oversight Consultant

    1 week ago

    Tallahassee, Florida, United States State of Florida Full time

    Role ResponsibilitiesProvides consultation and develops/participates in program policy, operating procedures, handbooks, manuals, the client data management system, rules and agreements.Consultation as requested for APD facility activities to assure compliance with nursing standards and policies; Specialized projects as requested (includes Agency...

  • Clinical Pharmacist Medication Therapy Specialist

    3 days ago

    Tallahassee, Florida, United States Optum Full time

    At Optum, we strive to deliver exceptional care to millions of people around the world. As a Clinical Pharmacist on our Practice Extend Team, you will play a vital role in improving health outcomes by connecting patients with the right care and resources.About the RoleWe are seeking a highly skilled Clinical Pharmacist to join our team. In this role, you...

  • Practice Extend Clinical Pharmacist

    4 days ago

    Tallahassee, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...

  • Practice Extend Clinical Pharmacist

    2 weeks ago

    Tallahassee, United States Optum Full time

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion,...