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Authorization Utilization Review Bcba Jobs (NOW HIRING)

24-MAG LLC

Utilization Review Specialist

Manhattan, NY · Remote

$80/hr

Review end-to-end prior authorization workflows for medical and clinical services across multiple ... and utilization management judgmentEvaluate outputs for alignment with payer requirements, CMS ...

24-MAG LLC

Utilization Review Specialist

Manhattan, NY · Remote

$80/hr

Review end-to-end prior authorization workflows for medical and clinical services across multiple ... and utilization management judgmentEvaluate outputs for alignment with payer requirements, CMS ...

RECAP INC

Utilization Review Specialist

Middletown, NY

$27 - $34/hr

Monitor authorization expiration dates and ensure uninterrupted coverage for clients. * Coordinate peer-to-peer reviews, reconsiderations, and appeals for denied or reduced services. * Maintain ...

Acrisure, LLC

Utilization Review Nurse

Bradenton, FL · On-site

$55 - $90/hr

## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on ... authorized at the nurse level, and refers requests for physician review when additional clinical ...

Acrisure

Utilization Review Nurse

Bradenton, FL · On-site

... authorized at the nurse level, and refers requests for physician review when additional clinical ... Experience in utilization review or case management is highly beneficial, particularly within ...

Acrisure, LLC

$55 - $90/hr

## Utilization Review NurseApplyremote type: Hybridlocations: 1301 6th Ave W - BRADENTON, FLposted on ... authorized at the nurse level, and refers requests for physician review when additional clinical ...

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Authorization Utilization Review Bcba information

What is an authorization utilization review BCBA?

An Authorization Utilization Review BCBA is responsible for reviewing treatment plans, ensuring medical necessity, and obtaining insurance authorizations for applied behavior analysis (ABA) services. They analyze data, collaborate with clinicians, and communicate with insurance providers to optimize care while adhering to policies and guidelines. Their goal is to ensure that ABA services are both effective and appropriately funded within insurance requirements.

What does an authorization utilization review BCBA do?

An Authorization Utilization Review BCBA is primarily responsible for reviewing clinical documentation to determine the medical necessity of ABA services, preparing and submitting authorization requests to insurance companies, and responding to requests for additional information. The role involves collaborating closely with clinical staff, insurance representatives, and sometimes directly with clients or caregivers to ensure all documentation meets regulatory and payer requirements. You may also provide guidance to therapy teams on proper documentation and help streamline internal utilization review processes. This position requires balancing client advocacy with payer guidelines, making each day both detailed and dynamic.

What are the key skills and qualifications needed to thrive as an authorization utilization review BCBA?

To thrive as an Authorization Utilization Review BCBA, you need a strong background in applied behavior analysis, in-depth knowledge of utilization review processes, and active BCBA certification. Familiarity with insurance authorization platforms, electronic health record (EHR) systems, and current procedural terminology (CPT) coding is typically required. Excellent analytical skills, attention to detail, and effective communication abilities set outstanding candidates apart. These skills ensure accurate authorization decisions, regulatory compliance, and efficient collaboration with providers and insurance teams.

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Authorization Utilization Review Bcba jobs near you

Utilization Review Specialist

The Springs

North Little Rock, AR • On-site

$68K/yr

Full-time

Posted 3 days ago

New

Job description

) Utilization Review Specialist - North Little Rock, AR (72113)
Are you an experienced healthcare professional looking for an opportunity to make a difference in patient care management? We're seeking a Utilization Review Specialist to join our team in North Little Rock, AR, helping ensure effective resource use while maintaining high-quality care within a managed care system.
About the Role:
This position plays a key role in reviewing patient care plans, collaborating with interdisciplinary teams, and ensuring compliance with insurance and regulatory requirements. The right candidate will be detail-oriented, organized, and able to manage multiple priorities in a fast-paced, office-based environment.
Key Responsibilities:
  • Review and Update Records: Ensure patient records and care plans are accurate before submission to insurance providers.
  • Admissions & Discharges: Verify documentation for new admissions and discharges is complete and timely.
  • Daily Workflow: Prepare due lists, send update notifications, and follow up on pending authorizations.
  • Utilization Review: Conduct pre-authorizations and concurrent reviews to confirm the necessity and appropriateness of care.
  • Collaboration: Partner with providers, case managers, and other healthcare professionals to support effective care planning.
  • Compliance: Maintain adherence to state, federal, and organizational guidelines.
  • Appeals Management: Review and respond to appeals related to utilization decisions.
  • Quality Initiatives: Participate in projects aimed at improving patient outcomes and operational efficiency.
Qualifications:
  • Long-term care experience required
  • Active COTA or PTA license
  • Minimum 1 year of experience in MDS, COTA, PTA, or related field, preferably in a managed care setting
  • Strong understanding of managed care principles and clinical guidelines
  • Ability to handle a high caseload with excellent organizational skills
  • Experience or willingness to learn systems such as PCC, Care Auth, Net Health, Availity, and Home & Community services
  • Proficient in Microsoft Excel, Outlook, PDFs, and web-based platforms
Preferred Skills:
  • Experience with Electronic Health Record (EHR) systems
  • Strong multitasking abilities in a high-volume office setting
  • Effective communication and problem-solving skills
Work Environment:
  • On-site position at our North Little Rock, AR office
  • Fast-paced, team-oriented environment requiring strong time management and attention to detail

If you are looking for a role where your skills directly contribute to improving patient care and operational outcomes, we'd love to hear from you. Apply today to join our team!
#INDSAR

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