Utilization Review Clinician – ABA (Remote)

About the role

Centene is seeking a remote Utilization Review Clinician specialized in Applied Behavior Analysis (ABA) to evaluate prior authorization requests and ensure clinical documentation meets medical necessity standards. You will work with a national member base, reviewing ABA services for behavioral health and autism spectrum disorder needs.

Key responsibilities

• Conduct prior authorization reviews for ABA treatment plans, progress reports, and related documentation.
• Assess medical appropriateness of services against ABA regulatory guidelines and health plan policies.
• Monitor clinical effectiveness and efficiency of member care throughout the treatment continuum.
• Analyze behavioral health data to improve quality and utilization of services.
• Communicate with providers, members, and families to clarify care levels and educate on the utilization process.
• Provide feedback to leadership for process improvement and policy development.
• Perform additional duties as assigned while complying with all company policies.

Required profile

• Graduate of an accredited nursing program or a bachelor’s degree with 2‑4 years of related experience.
• 2+ years providing ABA services as a Board Certified Behavior Analyst (BCBA) or equivalent.
• License to practice independently (BCBA, LCSW, or equivalent) as required by state regulations.
• Master’s degree in behavioral health is preferred.

Required skills

• Strong knowledge of ABA treatment protocols and clinical documentation review.
• Understanding of medical necessity criteria and utilization management principles.
• Experience with prior authorization and managed care processes.
• Ability to analyze behavioral health data and identify improvement opportunities.

What we offer

• Competitive benefits package and flexible workplace policies.
• Fully remote schedule: Monday‑Friday, 8:00 AM‑5:00 PM.
• Opportunity to impact care for millions of members nationwide.