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From Home Authorization Utilization Review Bcba Jobs in Riverside, CA

KPC Health

Utilization Review RN

Santa Ana, CA · On-site

... from fiscal intermediary; gathering clinical and fiscal information and communicating status of ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

KPC Global MSO

Utilization Review RN

Santa Ana, CA · On-site

... from fiscal intermediary; gathering clinical and fiscal information and communicating status of ... Utilization Review and Case Management reporting * Able to work independently and use sound ...

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Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Responsible for the quality and resource management of all authorizations and referrals with the ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

Prime Healthcare

Utilization Review RN

Ontario, CA · On-site

$71K - $104K/yr

Responsibilities Responsible for the quality and resource management of all authorizations and ... At least 3 years of experience in utilization review, referrals, authorizations, denials and ...

KPC Global MSO

Utilization Review LVN

Santa Ana, CA · On-site

Job Title: Utilization Review LVN SUMMARY The purpose of the Utilization Management LVN is to ... Ensures members have a safe discharge plan in place prior to discharge from the inpatient setting.

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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 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.

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 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.

Can a From Home Authorization Utilization Review BCBA work remotely?

Yes, a From Home Authorization Utilization Review BCBA can work remotely, as many roles in behavioral health and utilization review are performed virtually. This position typically requires strong communication skills, certification, and familiarity with telehealth tools and electronic health records, allowing for flexible work environments.

Is utilization review work from home?

Utilization review roles, including those for BCBA professionals, are increasingly offered as remote positions, especially with the use of telehealth and digital documentation tools. Many employers allow work-from-home arrangements, but specific policies depend on the company and job requirements, such as certification and experience in behavioral health. Candidates should verify remote options during the application process or interview stage.

What cities near Riverside, CA are hiring for From Home Authorization Utilization Review Bcba jobs?

Cities near Riverside, CA with the most From Home Authorization Utilization Review Bcba job openings:

From Home Authorization Utilization Review Bcba jobs near you

Utilization Review Technician III

Prime Healthcare Management Inc

Ontario, CA • On-site

$24.65 - $30.03/hr

Other

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Prime Healthcare rating

6.4

Company rating: 6.4 out of 10

Based on 289 frontline employees who took The Breakroom Quiz

649th of 898 rated healthcare providers

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team! 

Responsibilities

The Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This position will also serve as a liaison and own the coordination with other UR techs in the team while being responsible for coordinating phone calls, data entry, mailing/faxing appeals and tracking data from various insurance providers and health plans regarding authorization, expedited reviews and appeals. Document and track all communication attempts with insurance providers and health plans and scan all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on all denials while working closely with the Corporate/Facility Utilization review teams, Business Office and Case Managers. The Utilization review tech will also serve as the primary contact and coordinate the work to maintain integrity of tracking government review audits (RAC, MAC, CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The Utilization review tech will further support the department needs for Release of Information through faxing and mailing, discharge coordination or other duties as assigned.

Qualifications
  • Bachelor’s degree or four years of relevant experience required.
  • Microsoft office proficiency.
  • Good communication skills

    • Preferred qualifications:

  • Completion of a medical terminology course; preferred.
  • Knowledge of HIPAA regulations preferred.
    • Pay Transparency

    Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $24.65 to $30.03. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

    Employment Status Full Time Shift Days Equal Employment Opportunity

    Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

      Privacy Notice

    Privacy Notice for California Applicants:https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf

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