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Authorization Utilization Review Bcba Jobs (NOW HIRING)

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

Verify insurance benefits , coordinate authorizations, and communicate effectively with managed ... As a Utilization Review Specialist , you'll help ensure that each client leaves treatment with a ...

HHC

UTILIZATION REVIEW SPECIALIST

Indianapolis, IN · On-site

Interfaces with Pharmacy and Specialty Clinic staff to initiate authorization of biological and ... Utilization Review nurses' team to ensure timely patient progression through the episode/plan of ...

Sheppard Pratt

Utilization Review Specialist

Towson, MD · On-site

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing ... Also responsible for securing authorizations and tracking entitlements for enrolled clients.

The Meadows

Utilization Review Coordinator

Phoenix, AZ · On-site +1

As the Utilization Review Coordinator, you will develop and implement systems for authorizations ... Monitor each step of the authorization process to proactively identify potential problems and ...

tmn

Utilization Review Specialist

Akron, OH · On-site

$40K/mo

SUMMARY The Utilization Review Specialist is responsible for proactive planning measures, accurate ... Provides professional oversight of service delivery authorizations and assurances, effective ...

Sheppard Pratt

Utilization Review Specialist

Towson, MD · On-site

$26.04/hr

Responsible for supporting the utilization review system including data analysis, report writing ... Also responsible for securing authorizations and tracking entitlements for enrolled clients.

Lifepoint Health

Utilization Review Director

Englewood, CO · On-site

$52 - $71/hr

The UR Director will report consistently and accurately to the CEO or delegate the authorization ... Previous utilization review experience in a psychiatric healthcare facility preferred. * License:

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Authorization Utilization Review Bcba information

What are the key skills and qualifications needed to thrive in the Authorization Utilization Review Bcba position, and why are they important?

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.

What are the primary responsibilities of an Authorization Utilization Review BCBA on a typical day?

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 is an Authorization Utilization Review BCBA job?

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.

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Authorization Utilization Review Bcba jobs near you
Utilization Review Specialist

Utilization Review Specialist

BriteLife Recovery

Englewood, NJ • On-site

Full-time

Posted 17 days ago

Job description

) What you will be doing?
The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife Recovery. This role ensures timely approvals and continued stay authorizations from insurance payers by effectively communicating clinical information and advocating for appropriate levels of care.
The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access to treatment and maintain financial viability for the organization. Success in this role requires strong clinical judgment, documentation skills, familiarity with ASAM criteria, and a working knowledge of insurance guidelines specific to behavioral health
What tasks are required?
  • Conduct initial and concurrent reviews for detox, residential, partial hospitalization (PHP), and intensive outpatient (IOP) levels of care.
  • Obtain prior authorizations and continued stay approvals from commercial and other payers by submitting timely clinical reviews and documentation.
  • Communicate clinical necessity of services based on ASAM criteria and DSM-5 diagnoses.
  • Track and document all insurance-related communications, decisions, and outcomes in the EHR and UR logs.
  • Collaborate with clinicians, therapists, case managers, and medical staff to gather accurate and up-to-date clinical information for reviews.
  • Ensure treatment plans, progress notes, and assessments are completed on time and accurately reflect medical necessity.
  • Participate in multidisciplinary team meetings to stay informed on client progress and treatment goals.
  • Assist staff with proper documentation practices to support insurance justification and compliance.
  • Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols.
  • Monitor trends in denials, approvals, and length-of-stay metrics to support organizational performance improvement.
  • Assist in appeals and peer reviews by gathering required documentation and preparing clinical summaries.
  • Provide training and support to staff on documentation best practices related to utilization review.
  • Special projects as assigned

What we need from you?
  • Minimum of 2-3 years of experience in utilization review, case management, or insurance coordination in a behavioral health or substance use treatment setting.
  • Knowledge of ASAM criteria and levels of care for substance use and co-occurring disorders.
  • Familiarity with managed care principles, insurance authorizations, and payer requirements.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Excellent organizational, communication, and time management skills.
  • Proficiency in Electronic Health Records (EHRs), insurance portals, and Microsoft Office tools.
  • Bachelor's degree in Nursing, Social Work, Psychology, or a related field required; advanced degree or licensure (e.g., RN, LCSW, LPC, LMHC, or CADC) preferred.
  • Experience or working knowledge with Collaborative MD and KIPU
  • Experience in detox and residential SUD programs.
  • Knowledge of major insurance provider platforms (e.g., Optum, Aetna, BCBS, Cigna).
  • Strong clinical writing skills and familiarity with medical necessity language.
  • Ability to advocate for clients while balancing payer relationships and compliance.
  • Ability to lift up to 25 pounds.
  • Ability to walk up and down stairs during emergency drills or situations.

All ARS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. ARS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.

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