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Part Time Bcba Utilization Review Jobs in Florida

Baptistfirst

Previous inpatient hospital case management experience including utilization review (third party ... Regular-Part time Shift : First Shift (United States of America)

Golden Care Therapy

FL · On-site

$60 - $85/hr

BCBA Pay: $60.00 - $85.00 per hour Job Type: Part Time/Possibility for Full Time Benefits: · ... Annual performance reviews are conducted to provide constructive feedback and support professional ...

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Part Time Bcba Utilization Review information

What is a part time BCBA utilization review?

A Part Time BCBA Utilization Review position involves a Board Certified Behavior Analyst (BCBA) reviewing treatment plans and clinical documentation to ensure that applied behavior analysis (ABA) services are medically necessary, effective, and compliant with insurance or regulatory guidelines. This role typically does not provide direct therapy but focuses on evaluating the quality and justification of ABA services for approval or reimbursement. Working part time, these BCBAs help organizations maintain high standards of care while ensuring that treatment protocols align with best practices and payer requirements.

How does a part time BCBA utilization review typically collaborate with other healthcare professionals?

As a part-time BCBA in Utilization Review, you will regularly interact with clinicians, case managers, and insurance representatives to assess the medical necessity and effectiveness of behavior analytic services. Collaboration often involves reviewing clinical documentation, providing recommendations, and participating in multidisciplinary team meetings to ensure clients receive appropriate care. Strong communication skills and an understanding of insurance guidelines are essential for successful teamwork in this fast-paced, detail-oriented environment.

What are the key skills and qualifications needed to thrive as a part time BCBA utilization review specialist?

To thrive as a Part Time BCBA Utilization Review Specialist, you need board certification as a Behavior Analyst (BCBA), strong understanding of ABA principles, and experience in clinical case review. Familiarity with electronic health records (EHRs), utilization management software, and compliance with insurance and regulatory guidelines is typically required. Outstanding analytical thinking, attention to detail, and effective written and verbal communication skills set top performers apart in this role. These skills ensure accurate, fair, and timely case evaluations that support quality care and compliance with payer requirements.

What is the difference between Part Time Bcba Utilization Review vs Part Time Bcba?

AspectPart Time Bcba Utilization ReviewPart Time Bcba
CredentialsBCBA certification, additional training in utilization reviewBCBA certification
Work EnvironmentHealthcare or insurance companies, reviewing casesBehavior analysis settings, direct client work
Employer & IndustryInsurance providers, healthcare organizationsBehavior therapy clinics, schools, private practice
Job FocusReviewing treatment plans for insurance approvalDeveloping and implementing behavior intervention plans

Part Time Bcba Utilization Review primarily involves evaluating treatment plans for insurance coverage, focusing on case review and approval. In contrast, Part Time Bcba emphasizes direct client intervention and behavior analysis. Both roles require BCBA certification but differ in work environment and job responsibilities.

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For Part Time Bcba Utilization Review jobs in Florida, the most frequently searched job titles are:

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Part Time Bcba Utilization Review jobs near you
Infographic showing various Part Time Bcba Utilization Review job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, 2% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Senior Utilization Review Specialist - Part Time

Sage Clinical RCM, LLC

Saint Petersburg, FL • On-site

Part-time

Posted 4 days ago

Job description

Description:Position Summary

The Part Time Senior Utilization Review Specialist is an experienced registered nurse responsible for concurrent and retrospective review of hospital services to support appropriate utilization, accurate patient status, timely payer authorization, and medical necessity compliance. This senior individual-contributor role serves as a clinical resource for complex cases and partners with physicians, care management, patient access, coding, and revenue cycle teams to reduce avoidable denials and support appropriate reimbursement.

Key Responsibilities

• Perform concurrent and retrospective utilization review for assigned inpatient, observation, and outpatient cases using approved criteria, payer policies, and clinical judgment.

• Apply InterQual, MCG, or client-approved criteria to support medical necessity, level of care, continued stay, and patient-status determinations.

• Obtain, submit, and track payer notifications and authorizations; communicate clinically relevant information to payer medical-management teams within required time frames.

• Identify potential medical-necessity, authorization, status, and documentation risks early and escalate appropriately to prevent avoidable denials.

• Collaborate with physicians, case management, CDI, coding, patient access, and revenue cycle partners to clarify documentation and support appropriate care progression.

• Coordinate clinical information and deadlines for peer-to-peer review or denial escalation when needed; maintain complete, accurate documentation in the designated systems.

• Serves as a member of the Utilization Review Committee-prepares reports to include utilization trends, denial patterns, extended stays, and workflow barriers; communicate actionable findings to leadership.

• Performs escalations to UR Committee members to ensure that compliance with regulations for patient status changes by providers are occurring per policy. Documents escalations and presents outcomes to UR committee.

• Serve as a senior clinical resource, providing guidance and support on complex review questions while adhering to established policies and escalation pathways.

• Participate in quality audits, education, process improvement, and other initiatives that strengthen utilization management performance.

Requirements:Required Qualifications

• Current, unrestricted RN license.

• Five or more years of acute-care hospital experience, including at least three years in utilization review, utilization management, case management, or a closely related function.

• Demonstrated experience applying medical-necessity and level-of-care criteria, including concurrent review and continued-stay review.

• Working knowledge of inpatient versus observation status, payer authorization requirements, Medicare and managed-care utilization principles, and denial-prevention practices.

• Strong clinical judgment, prioritization, documentation, communication, and collaborative problem-solving skills.

• Ability to independently manage a high-volume, deadline-driven caseload while exercising sound judgment regarding escalation.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).

• Certification in case management or utilization management, such as CCM or ACM.

• Experience with InterQual, MCG, Cerner, or comparable utilization-management and electronic health-record systems.

• Experience supporting hospital denials management, peer-to-peer coordination, or care-progression initiatives.


Role Boundaries and Work Expectations

• This is a senior individual-contributor role and does not include direct people management unless separately assigned.

• The specialist follows St. John's Health clinical policies, payer requirements, and established Sage Clinical RCM workflows.

• The role requires discretion with protected health information and strict compliance with HIPAA, client security standards, and applicable regulations.

• Availability during agreed hospital business hours and participation in required meetings, education, and workflow updates are expected.