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Authorization Utilization Review Bcba Jobs in Iowa

Trinity Health

Case Manager RN

Des Moines, IA · On-site

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

Trinityhealth

Case Manager RN

Des Moines, IA · On-site

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

Trinity Health

Case Manager RN

Des Moines, IA · On-site

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

Trinity Health

Case Manager RN

Des Moines, IA · On-site

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

Trinityhealth

Case Manager RN

Des Moines, IA

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

Trinity Health

Case Manager RN

Des Moines, IA · On-site

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

Trinityhealth

ED RN Case Manager Nights

Des Moines, IA · On-site

Accurately document utilization review activities, status determinations, authorizations, denials, and communications in the medical record and STAR system. * Submit timely clinical information to ...

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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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Infographic showing various Authorization Utilization Review Bcba job openings in Iowa as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Senior Review Coordinator (Oncology) - Utilization Management (RN)

Telligen

West Des Moines, IA • On-site

Full-time

Re-posted 3 days ago

Telligen rating

7.9

Company rating: 7.9 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

36th of 72 rated business consultants

Job description

This position will be responsible for conducting utilization review/medical management for all services including training/mentoring other team members and performing preliminary research on requested topics. In addition, the incumbent may provide technical assistance, medical record review and support to provider staff and physician reviewers.
 
What you'll do:
  • Perform prospective, concurrent or retrospective utilization review/medical management for all services including appropriateness of quality of care based on contract, state, or URAC requirements.
  • Screen individual situations according to specific criteria to determine if care is appropriate.
  • Refer cases that fail to meet screening criteria to peer reviewer.
  • Coordinate and participate in peer-to-peer review as warranted. With prior management approval, may deviate from criteria with proper justification to authorize the service.
  • Serve as liaison between peer reviewer, provider, facility and/or subscriber.
  • Coordinate and participates in appeal process as directed by management.
  • Train or serve as a mentor to team members and physician reviewers to ensure reviews and appeals are conducted thoroughly and within specified time frames.
  • Performs preliminary research on topics such as experimental or cosmetic services, coverage determinations, coding or standards of care.
  • Documents review and special project results in workflow documentation system, ensuring data is accurate and timely.
  • Assists in compliance reporting.
  • Performs miscellaneous duties as assigned.
Required Skills and Experience
  • Current RN license that is recognized in the relevant jurisdiction(s)or other certification directly relevant to the type of review performed; Ability to obtain required license(s) in state(s) by timeframe set by business not to exceed 6 months
  • Current RN license must be unrestricted and if there is a restriction that is allowed by a relevant jurisdiction, according to the Medical Director, it is of the type that does not affect the health professional’s ability to fulfill the roles and responsibilities of a reviewer
  • Four-year degree in health care or two- or three-year degree in nursing or related field and/or equivalent training and/or experience
  • 3 – 5 years recent experience working in a clinical environment
  • 5% local and/or overnight travel
 
 
Preferred Skills and Experience
  • Knowledge of URAC standards 
  • Oncology experience highly preferred
Who We Are:
 
Telligen is one of the most respected population health management organizations in the country. We offer clinical, analytical, and technical expertise to support local, Tribal, and national partners, state and federal government programs, and employers and health plans.
 
Over our 50-year history, health care has evolved - and so have we. What hasn't changed is our deep commitment to those we serve. Our success is built on our ability to adapt, respond to client needs and deliver innovative, mission-driven solutions.
 
Our business is our people and we’re seeking talented individuals who share our passion and are ready to take ownership, make an impact and help shape the future of health.
 
Are you Ready?
 
We’re on a mission to transform lives and economies by improving health.
 
Ownership: As a 100% employee-owned company, our employee-owners drive our business and share in our success.
Community: We show up - for our clients, our communities and each other. Being a responsible corporate partner is part of who we are.
Ingenuity: We value bold ideas and calculated risks. Innovation thrives when we challenge the status quo and listen to diverse perspectives.
Integrity: We foster a respectful, inclusive, and collaborative environment built on trust and excellence.
  
Thank you for your interest in Telligen!
Follow us on Twitter, Facebook, and LinkedIn to learn more about our mission-driven culture and stay up to speed.
 
While we use artificial intelligence tools to enhance our initial screening process, all applications are thoroughly reviewed by our human recruitment team to ensure a fair and comprehensive evaluation of each candidate.
Telligen and our affiliates are Equal Opportunity Employers and E-Verify Participants.
Telligen will not provide sponsorship for this position. If you will require sponsorship for work authorization now or in the future, we cannot consider your application at this time. We will not accept 3rd party solicitations from outside staffing firms.
 
Telligen is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, protected veteran status, disability or any other protected class.
 
Telligen is committed to ensuring that our employment process is open to all individuals, and provides reasonable accommodations to individuals who need assistance during any part of the employment process due to a disability, medical condition, or physical or mental impairment. Reasonable accommodations are considered on a case-by-base basis.
 
If you need assistance to navigate Telligen’s careers website or to apply for a position, please send an email to careers@telligen.com

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

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