BCBA Utilization Reviewer
1 week ago
Acentra Health is seeking a highly skilled BCBA Utilization Reviewer to join our team. As a key member of our organization, you will play a critical role in ensuring the delivery of high-quality healthcare services to our clients.
Key Responsibilities- Medical Record Review: Utilize your clinical expertise to review medical records for Applied Behavioral Analysis against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness.
- Review Types: Perform all applicable review types as workload indicates, accurately and timely. These may include both inpatient and outpatient review types.
- Decision-Making: Determine approval or initiate a referral to the physician consultant and process physician consultant decisions ensuring reason for the denial is described in sufficient detail on correspondence.
- Workload Management: Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet the workload demands of the department.
- Quality Monitoring: In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas.
- Knowledge Sharing: Maintain current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns.
- Customer Service: Functions as providers' liaison and contact/resource person for provider customer service issues and problem resolution.
- Training and Development: Attend training and scheduled meetings and for maintenance and use of current/updated information for review.
- Flexibility: Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs.
- Certification: Certification as a Board Certified Behavior Analyst (BCBA).
- Education and Experience: College degree and 4+ years of experience; or an equivalent combination of education and experience.
- Clinical Skills: Strong clinical assessment and critical thinking skills.
- Medical Record Abstracting: Medical record abstracting skills.
- Communication: Excellent verbal/written communication skills.
- Teamwork: Ability to work in a team environment.
- Organizational Skills: Flexibility and strong organizational skills.
- Technical Skills: Must be proficient in MS Office and internet/web navigation.
- State of Indiana Medicaid ABA Criteria: Knowledge of State of Indiana Medicaid ABA Criteria.
- UM/UR and/or Prior Authorization Experience: Minimum of one year UM/UR and/or Prior Authorization experience, strongly preferred.
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Marquand, Missouri, United States Acentra Health Full timeAbout the RoleAcentra Health is seeking a highly skilled BCBA Utilization Reviewer to join our team. As a key member of our clinical review team, you will play a critical role in ensuring the quality and accuracy of our review processes.Key ResponsibilitiesUtilize clinical expertise to review medical records for Applied Behavioral Analysis against...
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