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From Home Authorization Utilization Review Bcba Jobs

Banyan

Utilization Review Specialist

Pompano Beach, FL · On-site

$50K - $65K/yr

Remote flexibility - work from anywhere while collaborating with clinical, billing, and operations ... Verify insurance benefits, coordinate authorizations, and communicate effectively with external ...

US Tech Solutions

Utilization Review Nurse

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 ...

Discovery Institute

Utilization Review

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 ...

Nationwide Children's Hospital

Schedule: Monday-Friday (8:00am-4:30pm) Position is work from home after a 90 day in-office ... Performs pre-certifications, pre-authorizations, re-authorization, concurrent utilization reviews ...

Franciscan Health

Utilization Review Coordinator

Work From Home Work From Home Work From Home, Indiana 46544 The Utilization Review Coordinator performs admission screening for patients in a bed for medical necessity, and reviews for ...

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From Home Authorization Utilization Review Bcba information

What is a from home Authorization Utilization Review BCBA?

A 'From Home Authorization Utilization Review BCBA' is a Board Certified Behavior Analyst (BCBA) who works remotely to review and authorize treatment plans for clients, typically in the field of applied behavior analysis (ABA). Their primary responsibility is to evaluate submitted treatment requests, ensure they meet clinical guidelines and insurance requirements, and approve or deny them accordingly. This role combines clinical expertise with administrative tasks and is essential for maintaining quality and compliance in ABA therapy services. Working from home allows BCBAs to perform these duties flexibly, using secure online systems to review documentation and communicate with providers.

What is the difference between From Home Authorization Utilization Review Bcba vs From Home Authorization Utilization Review Bcba?

AspectFrom Home Authorization Utilization Review Bcba

Since the comparison is with the same job title, there is no difference between From Home Authorization Utilization Review Bcba and itself. Typically, variations may exist based on employer or specific job duties, but the core credentials, work environment, and industry usage remain consistent for this role.

What are some common challenges faced by a from home Authorization Utilization Review BCBA, and how can they be managed?

A remote Authorization Utilization Review BCBA often encounters challenges such as limited direct client interaction, reliance on thorough documentation, and navigating varying payer requirements. Staying organized and maintaining clear, detailed case notes are crucial for accurate reviews and justifying treatment authorizations. Regular communication with clinical teams and payers, as well as utilizing secure telehealth and documentation platforms, can help manage these challenges. Being proactive about ongoing training in payer guidelines also ensures compliance and efficiency in the role.

What are the key skills and qualifications needed to thrive as a from home Authorization Utilization Review BCBA?

To thrive as a From Home Authorization Utilization Review BCBA, you need certification as a Board Certified Behavior Analyst (BCBA), a strong background in applied behavior analysis, and experience with clinical review processes. Familiarity with electronic health records (EHR), utilization management software, and insurance authorization systems is typically required. Strong analytical thinking, attention to detail, and effective communication are essential soft skills for collaborating remotely and ensuring accurate case evaluations. These skills enable efficient and evidence-based review of treatment requests, ensuring appropriate care and compliance with payer guidelines.
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From Home Authorization Utilization Review Bcba jobs near you

Clinical Authorization Specialist Utilization Review

HALLMARK YOUTHCARE RICHMOND INC

Richmond, VA • On-site

Other

Medical, Retirement

Posted 25 days ago

Job description

As a leading Residential Treatment Center in the Greater Richmond area, Hallmark Youthcare treats adolescents with emotional and behavioral challenges triggered by trauma. Treatment is provided in a warm and friendly environment by a group of well-trained, highly motivated staff that take pride in delivering quality care in a fast-paced environment.

We are seeking a detail-oriented Clinical Authorization Specialist (Utilization Review) to join our healthcare team. The ideal candidate will have experience in prior authorizations, insurance verification, utilization review, and medical necessity determinations. This role is responsible for ensuring that medical services are appropriately authorized, clinically supported, and compliant with payer guidelines before, during, and after patient care.

The Clinical Authorization Specialist serves as a liaison between healthcare providers, insurance companies, and patients to facilitate timely approvals while minimizing denials and delays in care.

In addition, this role maintains communication with referral sources (CSA/FAPT/IACCT) to coordinate placement and reimbursement standards for transfers from emergency placements and document submission to Magellan for Medicaid consideration.

****Key Responsibilities

  • Master's degree in health services field.
  • Review and process prior authorization requests for medical procedures, diagnostic testing, medications, therapies, and specialty services.
  • Evaluate clinical documentation to determine medical necessity using payer guidelines, evidence-based criteria, and insurance policies.
  • Perform prospective, concurrent, and retrospective utilization reviews.
  • Communicate with physicians, nurses, case managers, and insurance representatives to obtain required clinical documentation.
  • Submit authorization requests and monitor status through payer portals and electronic health record (EHR/EMR) systems.
  • Track authorization approvals, denials, appeals, and expiration dates to ensure continuity of care.
  • Identify incomplete or missing documentation and coordinate with providers to obtain necessary information.
  • Maintain accurate records of all authorization activities, communications, and determinations.
  • Stay current on payer policies, CMS regulations, and utilization management best practices.
  • Assist with appeals and peer-to-peer review coordination when necessary.
  • Meet productivity, turnaround time, quality, and compliance standards.

Required Qualifications

  • High school diploma or equivalent required; Associate's or Bachelor's degree in a healthcare-related field preferred.
  • Minimum of 2 years of experience in prior authorization, utilization review, medical insurance, case management, including admissions.
  • Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans.
  • Experience working with electronic medical records (EMR/EHR) and payer authorization portals.
  • Excellent organizational, analytical, and problem-solving skills.
  • Strong verbal and written communication abilities.
  • Ability to prioritize multiple tasks in a fast-paced healthcare environment.

Benefits:

Set schedule Monday- Friday 9 am- 5pm

Full benefit package available

Matching 401K

Time off accrued each payroll

Free employee meals

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