Utilization Review Clinician- ABA
3 hours ago
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) preferred 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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Utilization Review Clinician- ABA
2 weeks ago
Tallahassee, United States Centene Corporation Full timeYou 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...
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Clinical Utilization Review Specialist
3 weeks ago
Tallahassee, Florida, United States Centene Corporation Full timeJob Summary: We are seeking a skilled Clinical Utilization Review Specialist to join our team. As a Clinical Utilization Review Specialist, you will be responsible for reviewing member care and health status to determine medical appropriateness of Applied Behavior Analysis (ABA) services.Key Responsibilities:Evaluate member care and health status before,...
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Clinical Utilization Review Specialist
4 weeks ago
Tallahassee, FL, United States Centene Corporation Full timeJob Title: Utilization Review Clinician - ABAJoin Centene Corporation, a leading healthcare company, as a Utilization Review Clinician - ABA. In this role, you will play a critical part in ensuring the medical appropriateness of Applied Behavioral Analysis (ABA) services for our members.Key Responsibilities:Evaluate member care and health status before,...
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Product Quality Clinician Manager
3 weeks ago
Tallahassee, Florida, United States Edwards Lifesciences Full timeProduct Quality Clinician ManagerEdwards Lifesciences is seeking a highly skilled Product Quality Clinician Manager to join our team. As a key member of our Complaint Handling and Post Market Surveillance/Risk Management team, you will provide clinical guidance and expertise to Quality, Engineering, and other cross-functional teams to ensure the highest...
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Product Quality Clinician Manager
3 weeks ago
Tallahassee, United States Edwards Lifesciences Full timeThis position offers the flexibility of being either fully remote or hybrid remote, but the selected candidate must be residing within the United States.Imagine how your ideas and expertise can change a patient's life.Our Quality teams help shape the development of groundbreaking technologies to ensure each stage of our innovation process is held to the...
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Manager, Product Quality Clinician
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Tallahassee, United States Edwards Lifesciences Full time* This position offers the flexibility of being either fully remote or hybrid remote, but the selected candidate must be residing within the United States. Imagine how your ideas and expertise can change a patient's life. Our Quality teams help shape the development of groundbreaking technologies to ensure each stage of our innovation process is held to the...
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Tallahassee, Florida, United States CenterWell Home Health Full timeKey Responsibilities:As a Clinical Operations Director at CenterWell Home Health, you will be responsible for leading clinical operations in home health. This includes developing, planning, and implementing clinical operations, assessing and updating patient care plans, and assigning and managing caregivers. You will also oversee the delivery of care, make...
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Pediatric Medical Director
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Tallahassee, Florida, United States CenterWell Primary Care Full timeJoin Our Team as a Home Health Speech Language PathologistBecome a part of our caring community and help us put health first. As a Home Health Speech Language Pathologist, you will:Evaluate, direct, and provide speech/language pathology services to patients in the home or facility.Participate in the development and periodic review of the Plan of Treatment...
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