Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers' Compensation Medical Treatment Guidelines ...
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Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers' Compensation Medical Treatment Guidelines ...
Those fully remote associates residing in states where service is required by contract, law, or ... When necessary, cases are escalated to the Medical Director for further review. The reviewer ...
Those fully remote associates residing in states where service is required by contract, law, or ... When necessary, cases are escalated to the Medical Director for further review. The reviewer ...
Contingent UR/LTSS Registered Nurse
Washington, DC · Remote
$36 - $42/hr
Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better. This position is 100% remote , offering the ...
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Contingent UR/LTSS Registered Nurse
Washington, DC · Remote
$36 - $42/hr
Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better. This position is 100% remote , offering the ...
Those fully remote associates residing in states where service is required by contract, law, or ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Those fully remote associates residing in states where service is required by contract, law, or ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
Utilization Mangement Technician
Washington, DC · On-site +1
$27.02 - $36.78/hr
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ... faxes and authorizations related to prospective, concurrent and post service review functions.
Utilization Mangement Technician
Washington, DC · On-site +1
$27.02 - $36.78/hr
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ... faxes and authorizations related to prospective, concurrent and post service review functions.
Behavioral Health UM Review
Washington, DC · On-site +1
Role Overview Under the direction of the Supervisor, the Behavioral Health Utilization Management ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
Behavioral Health UM Review
Washington, DC · On-site +1
Role Overview Under the direction of the Supervisor, the Behavioral Health Utilization Management ... For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ...
BCBA (Part-time) (Remote)
Fairfax, VA · Remote
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80110/hr Flexible Schedule Hybrid (Remote + In ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
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BCBA (Part-time) (Remote)
Fairfax, VA · Remote
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80110/hr Flexible Schedule Hybrid (Remote + In ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
BCBA
Fairfax, VA · On-site +1
$90K - $110K/yr
Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ... Remote and in-clinic Job Types: Full-time
BCBA
Fairfax, VA · On-site +1
$90K - $110K/yr
Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ... Remote and in-clinic Job Types: Full-time
BCBA (Part-time)
Fairfax, VA · On-site +1
$80 - $110/hr
... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
BCBA (Part-time)
Fairfax, VA · On-site +1
$80 - $110/hr
... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
BCBA (Part-time)
Fairfax, VA · On-site +1
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
BCBA (Part-time)
Fairfax, VA · On-site +1
$80 - $110/hr
BCBA (Board Certified Behavior Analyst) - Part-time $80-110/hr Flexible Schedule Hybrid (Remote ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Assistant Clinical Director, ABA Services - BCBA
Fairfax, VA · On-site +1
$85K - $95K/yr
Assistant Clinical Director, ABA Services (BCBA) Remote | Full-Time | $5,000 Sign-On Bonus ... Review documentation, treatment plans, and clinical practices to ensure alignment with BACB ...
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Assistant Clinical Director, ABA Services - BCBA
Fairfax, VA · On-site +1
$85K - $95K/yr
Assistant Clinical Director, ABA Services (BCBA) Remote | Full-Time | $5,000 Sign-On Bonus ... Review documentation, treatment plans, and clinical practices to ensure alignment with BACB ...
Hybrid BCBA
Ashburn, VA · On-site +1
$75K - $92K/yr
This position has additional flexibility expecting 3 days in clinic and allowing 2 days remote. We ... Monitor and review client programs to analyze data, measure progress and make necessary changes to ...
Hybrid BCBA
Ashburn, VA · On-site +1
$75K - $92K/yr
This position has additional flexibility expecting 3 days in clinic and allowing 2 days remote. We ... Monitor and review client programs to analyze data, measure progress and make necessary changes to ...
Hybrid Clinical Supervisor/BCBA - Lanham - $10,000 sign on bonus
Lanham, MD · On-site +1
$18K/yr
... utilization and performance of all BCBAs within the clinic, including regular review of client ... Active BCBA in good standing with the Behavior Analyst Certification Board (BACB). Active state ...
Hybrid Clinical Supervisor/BCBA - Lanham - $10,000 sign on bonus
Lanham, MD · On-site +1
$18K/yr
... utilization and performance of all BCBAs within the clinic, including regular review of client ... Active BCBA in good standing with the Behavior Analyst Certification Board (BACB). Active state ...
The RN Utilization Manager is accountable for HCBS Review Case Managers who perform evaluation of ... Responsible for policies and procedures for the authorization, oversight and monitoring of member ...
The RN Utilization Manager is accountable for HCBS Review Case Managers who perform evaluation of ... Responsible for policies and procedures for the authorization, oversight and monitoring of member ...
The RN Utilization Manager is accountable for HCBS Review Case Managers who perform evaluation of ... Responsible for policies and procedures for the authorization, oversight and monitoring of member ...
The RN Utilization Manager is accountable for HCBS Review Case Managers who perform evaluation of ... Responsible for policies and procedures for the authorization, oversight and monitoring of member ...
Molecular Diagnostics Medicare Medical Director - Palmetto GBA
Washington, DC · On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Molecular Diagnostics Medicare Medical Director - Palmetto GBA
Washington, DC · On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Molecular Diagnostics Medicare Medical Director - Palmetto GBA
Washington, DC · On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Molecular Diagnostics Medicare Medical Director - Palmetto GBA
Washington, DC · On-site +1
$309K - $413K/yr
This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Software: Microsoft Office Suite.
Remote Authorization Utilization Review Bcba information
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.
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.
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RN Reviewer/ Workers' Compensation Utilization Review - REMOTE
Washington, DC • Remote
MICHIGAN PEER REVIEW ORGANIZATION
Contractor
Posted 12 days ago
Job description
iMPROve Health is seeking an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type.
BENEFITS:
- Make a Difference: Use your clinical knowledge to improve the quality of care patients receive.
- Professional Recognition: Join a network of highly respected experts in your specialty.
- Competitive Compensation: Receive fair pay for your time and expertise.
- Protect Standards of Care: Help uphold the integrity of your profession.
- Work Remotely: Review cases from the convenience of your home or office.
Qualifications
- Active, unrestricted RN license required; New York RN license strongly preferred.
- Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health.
- Working knowledge of Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria.
- Strong clinical assessment, critical thinking, and written communication skills.
- Experience reviewing medical records and determining medical necessity preferred.
Responsibilities
- Review treatment requests and medical records for medical necessity and guideline compliance.
- Apply Workers' Compensation Medical Treatment Guidelines and applicable regulatory requirements.
- Prepare clear, objective, and timely review determinations.
- Maintain confidentiality and comply with HIPAA and other applicable privacy requirements.
Technical Requirements
- Reliable high-speed internet/Wi-Fi connection.
- Secure home office environment with the ability to protect confidential information.
- Proficiency using web-based review platforms and Microsoft Office applications.
OTHER REQUIREMENTS:
- Must complete the electronic credentialing application and receive organizational approval prior to performing a case review.
- Must complete a conflict of interest attestation upon credentialing and prior to performing a case review.
- Active hospital medical staff privileges may be required, as applicable.
- Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status.
EOE/VET/Disability