Chicago, IL · On-site
Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and ... Must have prior authorization utilization experience * Experience with Medcompass Skills: * MUST ...
Chicago, IL · On-site
Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and ... Must have prior authorization utilization experience * Experience with Medcompass Skills: * MUST ...
Marlboro, NJ · On-site
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Marlboro, NJ · On-site
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Marlboro, NJ · On-site
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Marlboro, NJ · On-site
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Quick apply
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Marlboro, NJ · On-site
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Marlboro, NJ · On-site
Monitor authorization expiration dates and request extensions before expiration. * Communicate ... Participate in utilization review meetings and case conferences. * Generate reports on ...
Utilization Review (UR) Specialist Location: Chadds Ford, Pennsylvania (Hybrid / Remote Eligible ... Communicate authorization updates with clinical and admissions teams * Maintain accurate ...
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Utilization Review (UR) Specialist Location: Chadds Ford, Pennsylvania (Hybrid / Remote Eligible ... Communicate authorization updates with clinical and admissions teams * Maintain accurate ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Canton, MA · On-site
$55 - $60/hr
Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification
Canton, MA · On-site
$55 - $60/hr
Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification
Alpharetta, GA · On-site
Maintain accurate and timely documentation of utilization review activities and authorization decisions.Monitor resource utilization and recommend opportunities to improve quality, efficiency, and ...
Alpharetta, GA · On-site
Maintain accurate and timely documentation of utilization review activities and authorization decisions.Monitor resource utilization and recommend opportunities to improve quality, efficiency, and ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Bradenton, FL · On-site
Utilization Review Nurse, LPN Acrisure is seeking a Utilization Review Nurse, LPN to evaluate ... authorized at the nurse level, and refers requests for physician review when additional clinical ...
New
Bradenton, FL · On-site
Utilization Review Nurse, LPN Acrisure is seeking a Utilization Review Nurse, LPN to evaluate ... authorized at the nurse level, and refers requests for physician review when additional clinical ...
New
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Gadsden, AL · On-site
Coordinate phone calls, data entry, and tracking related to authorizations, expedited reviews ... Utilization Review, Business Office, and Case Management teams * Maintain accurate tracking of ...
Ensures optimal reimbursement from governmental third-party payers', obtaining proper authorization. A strong utilization review professional ensures medical necessity, appropriate level of care ...
Quick apply
Ensures optimal reimbursement from governmental third-party payers', obtaining proper authorization. A strong utilization review professional ensures medical necessity, appropriate level of care ...
Pompano Beach, FL · Remote
$45K - $65K/hr
Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Mission-driven work with real business impact -- your authorizations directly determine whether ...
Pompano Beach, FL · Remote
$45K - $65K/hr
Utilization Review Specialist | Remote | Full-Time $50,000 - $65,000 Annually | Weekdays (Weekend ... Mission-driven work with real business impact -- your authorizations directly determine whether ...
Fremont, CA · On-site
$32.35 - $43.63/hr
Utilization Review Liaison Salary Range: $32.35 - $43.63 + applicable differentials Under the ... The UR Liaison is responsible for coordinating insurance reviews and issuance of authorization ...
New
Fremont, CA · On-site
$32.35 - $43.63/hr
Utilization Review Liaison Salary Range: $32.35 - $43.63 + applicable differentials Under the ... The UR Liaison is responsible for coordinating insurance reviews and issuance of authorization ...
New
Baltimore, MD · Remote
$51/hr
Utilization Review Specialist (BCBA Licensee) Location: Baltimore, MD (Remote - offsite) Type ... Perform prospective, concurrent, and retrospective reviews to determine authorization, medical ...
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Baltimore, MD · Remote
$51/hr
Utilization Review Specialist (BCBA Licensee) Location: Baltimore, MD (Remote - offsite) Type ... Perform prospective, concurrent, and retrospective reviews to determine authorization, medical ...
Baltimore, MD · Remote
$51/hr
Utilization Review Specialist (BCBA Licensee) Location: Baltimore, MD (Remote - offsite) Type ... Perform prospective, concurrent, and retrospective reviews to determine authorization, medical ...
Quick apply
Baltimore, MD · Remote
$51/hr
Utilization Review Specialist (BCBA Licensee) Location: Baltimore, MD (Remote - offsite) Type ... Perform prospective, concurrent, and retrospective reviews to determine authorization, medical ...
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.
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.
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.
Cities with the most Authorization Utilization Review Bcba job openings:
The most popular types of Authorization Utilization Review Bcba jobs are:
States with the most job openings for Authorization Utilization Review Bcba jobs include:
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Chicago, IL
Contract
Job Description:
Participates in the development and ongoing implementation of QM Work Plan activities.
Improve quality products and services, by using measurement and analysis to process, evaluate and make recommendations to meet QM objectives
Responsibilities:
Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.
Considers all documented system information as well as any additional records/data presented to develop a determination or recommendation.
Data gathering requires navigation through multiple system applications.
Staff may be required to contact the providers of record, vendors, or internal Aetna departments to obtain additional information.
Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines.
Responsible for the review and evaluation of clinical information and documentation.
Reviews documentation and interprets data obtained form clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
Works Potential Quality of Care cases across all lines of business (Commercial and Medicare).
Independently coordinates the clinical resolution with internal/external clinician support as required.
Processes and evaluates complex data and information sets -Converts the results of data analysis into meaningful business information and reaches conclusions about the data
Prepares and completes QM documents based on interpretation and application of business requirements
Documents QM activities to demonstrate compliance with business, regulatory, and accreditation requirements
Assists in the development and implementation of QM projects and activities
Accountable for completing and implementation of QM Work Plan Activities
Experience:
3+ years of experience as an RN
Registered Nurse in state of residence
Must have prior authorization utilization experience
Experience with Medcompass
Skills:
MUST HAVE MEDCOMPASS or ASSURECARE exp.
MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge.
MUST HAVE UM experience, inpatient utilization management review.
MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG.
MUST HAVE 6 months of Prior Authorization.
Education:
Questionnaire:
Do you have experience with Medcompass?
Do you have experience with Prior Authorization?
Do you have experience with Utilization Review?
Do you have an Active Registered Nurse License?
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
