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Authorization Utilization Review Bcba Jobs in Virginia

Sentara Healthcare

UTILIZATION REVIEW NURSE

Norfolk, VA · On-site +1

The Utilization Review Nurse is responsible for utilization management services within the scope of ... Conducts primary functions of prior authorization, retrospective review, medical director referrals ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

$26 - $35/hr

... authorizations for residents in treatment. • Ensures coordinated effective resident care ... Assist in preparing Utilization Review Reports as necessary. • Coordinates and makes ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

... the authorizations for residents in treatment. · Ensures coordinated effective resident care ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

... the authorizations for residents in treatment. · Ensures coordinated effective resident care ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

New

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

... the authorizations for residents in treatment. · Ensures coordinated effective resident care ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

New

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

... authorizations and complete other pertinent processes. Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection ...

UHS

UTILIZATION COORDINATOR

Danville, VA

... the authorizations for residents in treatment. · Ensures coordinated effective resident care ... review and respond to concerns expressed by customers. Together with the appropriate Department ...

Centerbrite Health

BCBA

Fairfax, VA · On-site +1

$90K - $110K/yr

BCBA (Board Certified Behavior Analyst) We're building a care delivery model that replaces ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

Centerbrite Health

BCBA

Fairfax, VA · Hybrid

$90K - $110K/yr

BCBA (Board Certified Behavior Analyst) We're building a care delivery model that replaces ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

Centerbrite Health

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr • Flexible Schedule • Hybrid ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

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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 NURSE

Sentara Healthcare

Norfolk, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Sentara Health rating

6.7

Company rating: 6.7 out of 10

Based on 413 frontline employees who took The Breakroom Quiz

532nd of 895 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.
The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.
Responsible for written and/or verbal notification to members and providers. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.
Education:
• BSN (preferred)
Certification:
• Registered Nurse (required)
Experience:
• 3 years of acute care clinical experience (required)
• Previous Utilization Review experience (preferred)
• Milliman experience (preferred)
• Knowledge of NCQA (preferred)
• Microsoft suite (Word, Excel, Outlook) (preferred)
• Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Keywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQA
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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