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Remote Bcba Autism Utilization Review Jobs in Oregon

Centene

Clinical Appeals Coordinator

OR · On-site +1

$33.71 - $60.67/hr

Managed care or utilization review experience preferred. License/Certification: LPN, LVN, or RN ... with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an ...

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Remote Bcba Autism Utilization Review information

What is the difference between Remote Bcba Autism Utilization Review vs Remote Bcba Autism Case Manager?

AspectRemote Bcba Autism Utilization ReviewRemote Bcba Autism Case Manager
CertificationsBCBA, Autism-specific trainingBCBA, Autism-specific training
Work EnvironmentReviewing medical and insurance documentation remotelyCoordinating care and services remotely
Employer & IndustryHealthcare, insurance companies, therapy providers

Both roles require BCBA certification and focus on autism services, but the Autism Utilization Review primarily involves evaluating insurance claims and authorizations, while the Autism Case Manager coordinates ongoing care and services for clients. Understanding these differences helps professionals choose the role that best fits their skills and career goals.

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For Remote Bcba Autism Utilization Review jobs in Oregon, the most frequently searched job titles are:

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Infographic showing various Remote Bcba Autism Utilization Review job openings in Oregon as of August 2026, with employment types broken down into 86% Full Time, and 14% Part Time. Highlights an 100% Remote job distribution.

Clinical Appeals Coordinator

Centene

OR • On-site, Remote

$33.71 - $60.67/hr

Full-time

Medical, Retirement, PTO

Posted 24 days ago

Centene rating

8.4

Company rating: 8.4 out of 10

Based on 406 frontline employees who took The Breakroom Quiz

12th of 898 rated healthcare providers

Job description

Position Purpose:
Act as the liaison for all statewide appeals, fair hearings, review organizations, and other external type appeals. Responsible for ensuring that all appeal letters generated comply with both State and NCQA requirements.

Key Details: Must have an unencumbered RN, LVN or LPN license in the state of Oregon. This position will work Pacific Time Zone hours.

  • Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services requested.
  • Prepare reviews for cases that did not meet criteria
  • Gather, analyze and report verbal and written information regarding member and provider clinical appeals, including information follow up
  • Prepare response letters for member and provider clinical appeals and ensure letters are compliant with State and NCQA standards.
  • Maintain files and logs for all appeals
  • Coordinate with Medical Director(s) to clarify medical determinations or clinical rationale
  • Maintain current knowledge of NCQA and State regulations
  • Coordinate Fair Hearings with various internal departments and agencies
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience:
RN with 4+ years of clinical nursing and/or case management experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred.
License/Certification: LPN, LVN, or RN license.
Specialty Therapy Requirement: Master's degree in area of specialty therapy or equivalent experience. 3+ years of experience providing therapy services in healthcare or home health settings. Managed care or utilization review experience preferred.

Pay Range: $33.71 - $60.67 per hour

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.


Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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