Utilization Review Clinician – ABA

Centene Corporation

Utilization Review Clinician at Centene performing reviews of ABA services and monitoring clinical effectiveness. Engaging with healthcare providers and improving care processes as part of Medical Management team.

Posted 7/29/2026full-timeRemote • Florida • 🇺🇸 United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Applied Behavioral Analysis (ABA) services, including clinical evaluation and prior authorization reviews, while ensuring compliance with behavioral health standards. Strong ability to collaborate with healthcare providers and educate members and families on ABA processes.

Highest-signal resume keywords

BCBA CertificationBehavioral Health Clinical KnowledgeABA Utilization Review ProcessLCSW, LMHC, LPC, LMFT, or LMHP LicenseRN - Registered Nurse State Licensure

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Applied Behavioral Analysis (ABA)Clinical Effectiveness MonitoringPrior Authorization ReviewsData Analysis for Quality ImprovementAssessment of ABA Treatment Plans

Soft Skills

Interpersonal CommunicationProcess ImprovementEducation and Training

Certifications & Qualifications

Licensed Behavior Analyst (LBA)State Required Licensure

Industry Keywords

Behavioral Health (BH)Autism Spectrum DisorderHealthcare Provider CollaborationCare Services EvaluationClinical Standards Compliance

About the role

Key responsibilities & impact

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 regarding 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

Requirements

What you’ll need

Graduate of an Accredited School of Nursing or Bachelor's degree
2-4 years of related experience
2+ years providing ABA services as a BCBA
License to practice independently and/or have obtained the state required licensure as outlined by the applicable state (BCBA)
Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required
Knowledge of ABA services and BH utilization review process required
Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred
LCSW, LMHC, LPC, LMFT, or LMHP required
RN - Registered Nurse - State Licensure and/or Compact State Licensure with BCBA preferred
Licensed Behavior Analyst (LBA) where required by state required

Benefits

Comp & perks

Competitive pay
Health insurance
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules