NC Licensed Utilization Review Clinician

Job Summary

A company is looking for a Utilization Review Clinician - ABA.

Key Responsibilities

• Evaluates member's care and health status related to Applied Behavioral Analysis (ABA) services for medical appropriateness
• Performs prior authorization reviews for behavioral health to ensure compliance with ABA regulatory guidelines
• Analyzes behavioral health member data to enhance service quality and utilization

Required Qualifications, Training, and Education

• Graduate of an Accredited School of Nursing or Bachelor's degree with 2-4 years of related experience
• Licensure as a Clinical Social Worker, Mental Health Counselor, Professional Counselor, or equivalent required
• Behavioral health clinical knowledge with the ability to review ABA Treatment Plans
• Knowledge of ABA services and the behavioral health utilization review process
• Experience working with healthcare providers in relation to Applied Behavior Analysis Services preferred