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Authorization Utilization Review Bcba Jobs (NOW HIRING)

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 ...

Houston Healthcare

$80 - $100/hr

Work Shift The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of ... Current US state RN license with authorization to practice in the state of GA. Knowledge, Skills ...

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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

900 Emory Healthcare

Warner Robins, GA • On-site

$90 - $110/hr

Other

Posted 4 days ago

Job description

Work Shift

The Utilization Reviewer performs concurrent, extended stay and retrospective reviews of admissions using established criteria to determine appropriateness of admission and extended stay. The Utilization Reviewer serves as a resource to medical and hospital staff on utilization and regulatory issues and participates in coordination of individualized patient care services. The Utilization Reviewer plays an integral role in discharge planning and maximizing the continuum of care for patients assigned to his/her assigned unit. The Utilization Reviewer has the unique ability to follow the patient from admission to discharge and provide the physician and nursing staff with the best possible options for post hospital care for the patient.

Qualifications
  • Education & Training: Graduate of an accredited School of Nursing.
  • Experience: Three (3) years in an acute care setting.
  • Required Certification/Registration/Licensure: Current US state RN license with authorization to practice in the state of GA.

Knowledge, Skills & Abilities: Utilizes a variety of standard office equipment to include computer, printer, fax machine, copier, telephone etc. Basic knowledge of statistics encouraged.

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request.

Scheduled Weekly Hours: 40 FTE: 1 Expanded Work Shift: On Call:

Please note that one week's advance notice is preferred.

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