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Remote Authorization Utilization Review Bcba Jobs

Umpqua Health

Utilization Review Nurse

Roseburg, OR · On-site +1

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... This role conducts prior authorizations, facilitates care coordination, and supports safe ...

Umpqua Health

Utilization Review Nurse

Roseburg, OR · Remote

$85K - $105K/yr

UTILIZATION REVIEW NURSE REMOTE, ability to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470, as ... This role conducts prior authorizations, facilitates care coordination, and supports safe ...

Dane Street, LLC

Utilization Review Physician

Perform utilization review for: * Preauthorization requests * Appeals (first and second level ... Remote work from home * Full-time, Monday-Friday * Availability for occasional weekends and holiday ...

Oscar Health

Utilization Review Nurse

Tempe, AZ · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Bracane Co

Utilization Review Nurse

Plano, TX · Remote

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson ... This position is responsible for performing initial, concurrent review activities; discharge care ...

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Remote Authorization Utilization Review Bcba information

What are the key skills and qualifications needed to thrive as a Remote Authorization Utilization Review BCBA, and why are they important?

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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Remote Authorization Utilization Review Bcba jobs near you
Infographic showing various Remote Authorization Utilization Review Bcba job openings in the United States as of June 2026, with employment types broken down into 78% Full Time, 11% Part Time, and 11% Contract. Highlights an 11% In-person, and 89% Remote job distribution.
Utilization Specialist

Utilization Specialist

Lutheran Family Services

Lincoln, NE • On-site, Remote

Full-time

Posted 5 days ago

Job description

Utilization Specialist
Job Type
Full-Time
Position Summary:
  • The Utilization Specialist uses strong independent judgment to ensure access to medically necessary, high-quality behavioral health and community-based services across the agency. The Utilization Specialist ensures services align with medical necessity, reimbursement requirements, and regulatory standards, while supporting continuity of care, reducing denials, and promoting operational sustainability while maintaining a client-centered focus.
Job Duties:
  • Serve as a liaison between managed care organizations (MCOs), payers, and internal clinical and operational teams to support authorization, utilization management, and reimbursement processes.
  • Conduct utilization reviews to ensure services meet medical necessity criteria, payer requirements, and continued stay expectations.
  • Monitor authorizations, service units, length of stay, and extensions; proactively communicate issues that may impact service delivery or reimbursement.
  • Coordinate pre-certifications and authorization requirements prior to service initiation in collaboration with admissions and intake staff.
  • Initiate and manage appeals for denied services or continued stay determinations, including facilitating peer-to-peer reviews as needed.
  • Review clinical documentation within the electronic health record to ensure accuracy, timeliness, and alignment with authorization and payer requirements.
  • Identify documentation gaps or compliance risks and provide guidance to staff on documentation standards and workflows.
  • Conduct quality and utilization reviews to assess appropriateness of services and compliance with payer and regulatory standards.
  • Monitor and report on non-certified days, denials, and utilization trends, including identifying root causes and opportunities for improvement.
  • Assist with internal, payer, and regulatory audits, including documentation review and response to data requests.
  • Develop and analyze utilization reports and metrics to support operational and clinical decision-making.
  • Provide training and ongoing education to staff on documentation standards, medical necessity, and utilization processes.
  • Serve as a resource for staff questions related to utilization management, documentation, and payer expectations.
  • Perform other duties as assigned to support program operations and organizational needs.
Required Skills/Abilities:
  • Expertise in utilization management, medical necessity, and managed care processes.
  • Strong written and verbal communication skills, with the ability to collaborate effectively across clinical, operational, and external stakeholders.
  • High attention to detail with strong organizational, analytical, and follow-through skills.
  • Proficiency in electronic health records and data tracking/reporting systems.
  • Able to analyze data, identify trends, and support process improvement efforts.
  • Commitment to confidentiality, ethical practice, and client-centered care.
  • Awareness and sensitivity of our constituents and the populations served by employees.
  • Regular and predictable attendance, and promptness for work.
  • Commitment to uphold the mission, vision, and values of Lutheran Family Services.
  • Support the organization’s objective to be an inclusive and accessible workplace.
Position Competencies:
  • Process Improvement
  • Relationship Building
  • Analytical Skills
  • Accountability
  • Communication Skills
Education and Experience:
  • High school diploma or equivalent required; bachelor’s degree in social work, behavioral health, nursing or related healthcare field preferred.
  • Two (2) years’ experience working with populations served by LFS or in a related clinical or behavioral health setting required.
  • Experience in community mental health, CCBHC, or nonprofit human services preferred.
  • Active LPN, RN, MSW, CSW, LPC, or another clinical license in Nebraska preferred.
Physical Requirements:
  • Prolonged periods of sitting and working on a computer.
  • Hybrid or remote work may be available based on operational needs.
  • Flexible scheduling required during audits, appeal deadlines, or high-volume authorization periods.
  • Company-issued laptop and cell phone.
  • Valid driver’s license, liability auto insurance, and ability to drive a personal vehicle for travel between office locations and/or program sites, as needed.
Lutheran Family Services is an equal opportunity employer. We do not discriminate against any employee or applicant for employment on the basis of age, race, religion, color, ethnicity, disability, gender, sexual orientation, gender identity, or national origin.

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