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Remote Bcba Utilization Review Jobs in Arizona (NOW HIRING)

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;

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Remote Bcba Utilization Review information

What is a Remote BCBA Utilization Review?

Remote BCBA Utilization Review jobs involve Board Certified Behavior Analysts (BCBAs) who review and assess the medical necessity and effectiveness of Applied Behavior Analysis (ABA) therapy services, usually for insurance companies or healthcare organizations. These professionals work remotely to evaluate clinical documentation, ensure compliance with treatment guidelines, and approve or deny service requests based on established criteria. The role helps ensure that clients receive appropriate care while also managing costs for payers. Strong analytical and communication skills are essential, as is up-to-date BCBA certification.

What are the key skills and qualifications needed to thrive as a Remote BCBA Utilization Review?

To excel as a Remote BCBA Utilization Review specialist, you need Board Certified Behavior Analyst (BCBA) certification, in-depth knowledge of applied behavior analysis (ABA), and experience with clinical documentation standards. Familiarity with electronic health record (EHR) systems, utilization review platforms, and insurance authorization processes is typically required. Strong analytical thinking, attention to detail, and effective written communication distinguish top performers in this role. These competencies ensure accurate service reviews, compliance with payer requirements, and support for quality client care in a remote environment.

What are some common challenges faced by a Remote BCBA Utilization Review professional, and how can they be managed?

Remote BCBA Utilization Review professionals often encounter challenges such as balancing thorough case evaluations with productivity targets and adapting to varying documentation standards from different providers. Effective time management and strong communication skills are key to addressing these challenges. Additionally, staying current with payer guidelines and collaborating closely with clinical teams can help ensure accurate and efficient reviews, ultimately supporting high-quality care for clients.

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

AspectRemote Bcba Utilization ReviewRemote Bcba Case Manager
CertificationsBCBA, possibly additional utilization review credentialsBCBA, case management certifications often preferred
Work EnvironmentReviewing medical and treatment plans remotely, focusing on insurance and authorizationCoordinating care, managing cases, and supporting clients remotely
Employer & IndustryHealthcare, insurance companies, behavioral health providersBehavioral health agencies, healthcare organizations

Both roles require BCBA certification and involve remote work, but the Utilization Review focuses on evaluating treatment plans for insurance approval, while the Case Manager manages ongoing client care and services. Understanding these differences helps professionals choose the right career path in behavioral health.

What are the most commonly searched types of Bcba Utilization Review jobs in Arizona?

The most popular types of Bcba Utilization Review jobs in Arizona are:

What are popular job titles related to Remote Bcba Utilization Review jobs in Arizona?

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

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The top searched job categories for Remote Bcba Utilization Review jobs in Arizona are:

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Remote Bcba Utilization Review jobs near you

Utilization Review Nurse

Oscar Health

Tempe, AZ • Remote

$35 - $45.94/hr

Full-time

Re-posted 14 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

260th of 311 rated insurance

Job description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

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; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

  • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
  • Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
  • Meet required decision-making SLAs
  • Refer members for further care engagement when needed
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
  • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
  • Ability to obtain additional state licenses to meet business needs
  • 1+ year of utilization review experience in a managed care setting
  • Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual
  • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
  • Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

  • BSN
  • Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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