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From Home Utilization Management Bcba Jobs (NOW HIRING)

CVS Health

MI · On-site

$29.10 - $62.32/hr

UM Nurse Consultant Fully Remote- WFH Schedule : Monday-Friday 10:30AM- 7:30PM Position Summary: UM ... Utilization Management experience Education Associates Degree in Nursing required BSN preferred ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

$35 - $40/hr

The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Valenz

Utilization Management Nurse

Phoenix, AZ · On-site

... from care navigation and management to payment integrity, plan performance and provider ... About This Opportunity: As a Utilization Management Nurse, you'll oversee and manage the ...

Wellpath

Director Utilization Mgmt

Lemoyne, PA · On-site

$199K - $249K/yr

... for home and auto loans *Eligibility for perks and benefits varies based on employee type and ... O.) from an accredited university Experience * One (1) year of experience in utilization management ...

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... Current RN license from Maryland Board of Nursing. Working Conditions, Equipment, Physical Demands:

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How much do from home utilization management bcba jobs pay per year?

As of Aug 19, 2026, the average yearly pay for from home utilization management bcba in the United States is $89,075.00, according to ZipRecruiter salary data. Most workers in this role earn between $74,000.00 and $90,500.00 per year, depending on experience, location, and employer.

What is the difference between From Home Utilization Management Bcba vs From Home Behavior Analyst?

AspectFrom Home Utilization Management BcbaFrom Home Behavior Analyst
CertificationsBCBA or BCaBA, plus utilization management trainingBCBA or BCaBA, with behavior analysis certification
Work EnvironmentUtilization review, insurance companies, healthcare settingsBehavior therapy, client homes, clinics, schools
Employer & Industry UsageHealth insurance providers, managed care organizationsBehavior analysis agencies, educational institutions

From Home Utilization Management Bcba focuses on reviewing and approving treatment plans within healthcare and insurance settings, often involving utilization review. In contrast, From Home Behavior Analyst primarily provides direct behavioral therapy and assessments to clients, often in home or clinical environments. Both roles require BCBA certification but differ in daily tasks and work settings.

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What are the most commonly searched types of Utilization Management Bcba jobs?

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From Home Utilization Management Bcba jobs near you

Medical Director, Utilization Management (Commercial & MA)

HJ Staffing

Henderson, NV • On-site, Remote

Full-time

Medical

Posted 27 days ago

Job description

We are seeking a Medical Director of Utilization Management to lead and support the clinical integrity of our utilization management (UM) functions, with a primary focus on inpatient and post-acute care reviews.

In this role, you will ensure timely, consistent, and appropriate care determinations for Commercial and Medicare Advantage members. By leveraging evidence-based practices, CMS regulations, and health plan benefit structures, you will evaluate the medical necessity of care, participate in peer-to-peer consultations, and collaborate with multidisciplinary teams to drive optimal clinical outcomes, regulatory compliance, and cost efficiency.

Duration: August 10, 2026 - February 10, 2027

Location: Henderson, NV (100% Fully Remote Opportunity)

Reporting To: Chief Medical Officer

Start Date: Immediate Need

Key Responsibilities
  • Utilization Review & Medical Necessity: Conduct timely medical necessity determinations for inpatient admissions, continued stays, and post-acute care settings (SNF, IRF, LTACH, Home Health) for Commercial and Medicare Advantage populations.
  • Evidence-Based Evaluation: Apply nationally recognized guidelines (MCG, InterQual), CMS coverage criteria, and health plan policies to ensure appropriate level-of-care determinations.
  • Complex Case Escalation: Serve as the lead physician reviewer for complex, high-risk, or potentially adverse UM cases requiring clinical judgment.
  • Peer-to-Peer Engagement: Conduct peer-to-peer discussions with attending and treating physicians to clarify documentation, discuss options, and align on appropriate care plans.
  • Cross-Functional Collaboration: Partner with Care Management and UM teams to identify utilization trends, reduce avoidable readmissions/extended stays, and streamline care transitions.
  • Policy & Quality Support: Offer clinical expertise to support quality improvement initiatives, regulatory audit preparedness (CMS/NCQA), policy development, and UM committee activities.
  • Documentation & Compliance: Maintain precise, compliant, and timely documentation of all reviews and rationales in accordance with federal, state, and organizational guidelines.
Must-Have Qualifications
  • Education & Licensure: Active M.D. or D.O. degree with an active, unrestricted medical license in good standing (in state of residence).
  • Board Certification: Current Board Certification in an appropriate medical specialty.
  • Clinical & Leadership Experience: Minimum of 5 years of clinical practice, including at least 3 years of direct experience in utilization management, physician review, or medical leadership within a managed care or health plan setting.
  • Population Expertise: Demonstrated physician-level experience supporting Commercial and/or Medicare Advantage lines of business.
What Will Make You Successful
  • Criteria Proficiency: Advanced expertise with MCG guidelines and strong working knowledge of InterQual and CMS criteria.
  • Regulatory Knowledge: Deep understanding of Medicare Advantage regulations, Commercial health plan benefit structures, and state/federal UM mandates.
  • Technical Skills: Experience navigating medical management platforms, enterprise applications, and Microsoft Office products.
  • Communication & Negotiation: Exceptional written and oral communication skills, with a proven ability to handle delicate peer-to-peer discussions and articulate complex clinical rationales clearly.
  • Analytical Mindset: Strong problem-solving abilities, attention to detail, and a data-driven approach to identifying utilization trends and quality gaps.
Preferred Qualifications
  • Master's degree in Public Health, Business Administration, or Health Administration (MPH, MBA, or MHA).
  • Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).
Why Apply?

This is a 100% remote, high-impact contract opportunity starting immediately, offering you the flexibility of working from home while managing key clinical determinations for a dynamic health plan environment.

Employment Type: FULL_TIME

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