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Remote Authorization Utilization Review Bcba Jobs in Appleton, WI

Network Health WI

COB & Recovery Analyst

Menasha, WI · On-site +1

... authorizations, and other utilization management policies, etc. * Acts as a liaison between Payment Integrity and other operational departments for claim recovery issue resolution. * Reviews and ...

Network Health, Inc

COB & Recovery Analyst

Menasha, WI · On-site +1

... authorizations, and other utilization management policies, etc. * Acts as a liaison between Payment Integrity and other operational departments for claim recovery issue resolution. * Reviews and ...

Network Health

COB & Recovery Analyst

Menasha, WI · On-site +1

... authorizations, and other utilization management policies, etc. * Acts as a liaison between Payment Integrity and other operational departments for claim recovery issue resolution. * Reviews and ...

Bakertilly

Senior Specialist, Payroll

Appleton, WI · On-site +1

$28.75 - $39.25/hr

In order to be an authorized recruitment agency ("search firm") for Baker Tilly Advisory Group, LP ... review via our applicant tracking system. *While this position is mostly remote, team members must ...

Bakertilly

Senior Specialist, Payroll

Appleton, WI · On-site +1

$28.75 - $39.25/hr

In order to be an authorized recruitment agency ("search firm") for Baker Tilly Advisory Group, LP ... review via our applicant tracking system. *While this position is mostly remote, team members must ...

State of Wisconsin

Supervising Officer 1

Green Bay, WI · On-site +1

$47.68 - $51.36/hr

Job Details Applicants must be legally authorized to work in the United States (i.e. a citizen or ... As public safety employees, remote work is not an option for these positions. These positions have ...

State of Wisconsin

Physician 80%

Green Bay, WI · On-site +1

$98.58 - $126.13/hr

Job Details Applicants must be legally authorized to work in the United States (i.e. a citizen or ... This position is not eligible for remote work Shift: 0.8 FTE- days of the week will be determined ...

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Remote Authorization Utilization Review Bcba information

Can you work remotely as a remote authorization utilization review BCBA?

A remote authorization utilization review BCBA can typically perform their duties remotely, as the role involves reviewing clinical documentation and authorization requests, which can be done online. Successful remote work often requires strong communication skills, familiarity with electronic health records, and relevant certifications such as the BCBA credential. However, specific employer policies and state licensing requirements may influence the ability to work remotely in this role.

Is utilization review work from home?

Remote Authorization Utilization Review BCBA positions typically allow for work from home, especially when conducting chart reviews, documentation, and telehealth assessments. However, some roles may require occasional in-office visits or supervision, depending on employer policies and state regulations.

What are the key skills and qualifications needed to thrive as a remote authorization utilization review BCBA?

To thrive as a Remote Authorization Utilization Review BCBA, you need board certification as a Behavior Analyst (BCBA), deep knowledge of ABA therapy, and experience with clinical documentation and insurance authorization processes. Familiarity with electronic health record (EHR) systems, payer portals, and healthcare compliance tools is typically required. Strong analytical skills, attention to detail, and effective written communication are essential soft skills for success in this remote role. These competencies ensure accurate authorization reviews, compliance with regulations, and efficient support for patients and providers across virtual settings.

How does a remote authorization utilization review BCBA typically collaborate with healthcare providers and insurers during the review process?

A Remote Authorization Utilization Review BCBA frequently communicates with both healthcare providers and insurance representatives to assess and justify the necessity of ABA services for clients. This involves reviewing clinical documentation, clarifying treatment plans, and sometimes participating in peer-to-peer discussions to support authorization requests. Strong written and verbal communication skills are essential, as much of the collaboration is done via phone, email, or secure portals. Building positive relationships and ensuring clear, evidence-based recommendations can help streamline approvals and improve outcomes for clients.

What is a remote authorization utilization review BCBA?

A Remote Authorization Utilization Review BCBA is a Board Certified Behavior Analyst who works remotely to review and approve treatment plans for clients, typically in the context of Applied Behavior Analysis (ABA) therapy. Their main responsibility is to assess clinical documentation and ensure that the recommended services meet medical necessity criteria and payer guidelines. This role often involves collaborating with clinicians, insurance companies, and families to facilitate the authorization process for behavioral health services. Working remotely allows BCBAs in this position to provide their expertise from any location, using digital tools to conduct reviews and communicate with stakeholders.
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What job categories do people searching Remote Authorization Utilization Review Bcba jobs in Appleton, WI look for? The top searched job categories for Remote Authorization Utilization Review Bcba jobs in Appleton, WI are:
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Remote Authorization Utilization Review Bcba jobs near you
Infographic showing various Remote Authorization Utilization Review Bcba job openings in Appleton, WI as of July 2026, with employment types broken down into 69% Full Time, 17% Part Time, and 14% Contract. Highlights an 100% Remote job distribution.

RN Coordinator Utilization Management

Network Health WI

Menasha, WI • On-site, Remote

Full-time

Re-posted 29 days ago

Job description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:
  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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