2

Remote Bcba Utilization Review Jobs in Minnesota

Senior Superintendent II

Minneapolis, MN · Remote

$164K - $246K/yr

Review construction documents for completeness and constructability * Create, review and update ... Develop and implement site utilization plan and establish crew sizes * Select formwork systems and ...

Showing results 41-60

Remote Bcba Utilization Review information

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 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 the most commonly searched types of Bcba Utilization Review jobs in Minnesota?

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

What cities in Minnesota are hiring for Remote Bcba Utilization Review jobs?

Cities in Minnesota with the most Remote Bcba Utilization Review job openings:

Clinical Consultant - Remote

UnitedHealth Group

Eden Prairie, MN • On-site, Remote

Full-time

Retirement

Posted 24 days ago


UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

189th of 887 rated healthcare providers


Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Consultant serves as the primary liaison between OptumRx clinical operations, professional practice, clinical products and the Clinical Consultant's assigned client base. The role provides clinical support for OptumRx account management, operations, information technology, and other internal departments. The Clinical Consultant establishes client relationships and serves as primary point of contact for overall and day to-day service delivery for clinical pharmacy needs. This individual is relied upon to provide proactive clinical recommendations, information regarding pharmacy trend, clinical programs and products, and industry changes to clients, thereby fostering consultative relationships. This individual also represents client(s) internally and coordinates with other functional areas to implement client initiatives, complete projects, and address ongoing pharmacy service needs.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

  • Provide superior clinical consultation and clinical account management with a focus on client satisfaction, client retention, and trend management
  • Collaborate with clients to establish achievable but aggressive clinical program goals, including generic dispensing rate improvements, implementation of utilization management programs, improvement in medication adherence rates, improvements in therapy gaps for key chronic disease states, formulary compliance targets, and HEDIS & NCQA measures where applicable
  • Communicate drug information to clients and respond to plan-specific clinical inquiries
  • Stay aware of and provide clinical market intelligence to clients
  • Identify opportunities for clinical program up-sell and spearhead up-sell to assigned client(s)
  • Incorporate treatment and practice guidelines into client presentations including up-selling opportunities
  • Comprehend and effectively explain formulary and clinical program changes to clients
  • Effectively manage client objections to new programs and required changes
  • Identify and create opportunities to manage trend and add Optum products
  • Formulate client recommendations based on available data and trend
  • Deliver clinically sound and fiscally responsible recommendations to clients based on their trend
  • Routinely collaborate with account management to provide clinical aspects of client quarterly reviews
  • Analyze & interpret benefit designs
  • Collaborate in development of strategy as outward facing, dedicated or designated resource for assigned accounts, typically with direct client contact
  • Bring innovative ideas that can be scaled across the organization
  • Work in a collaborative manner with the Consultant(s) of assigned client(s) while maintaining focus on UHG and Optum strategies and goals
  • Clearly communicate analytical and reporting needs to supporting departments
  • Help clients be competitive within their market
  • Identify opportunities to increase efficiency
  • Manages/facilitates custom P&T committees for select clients, per contractual requirements
  • Provide education for clients, pharmacists, members and physicians per contractual requirements
  • Support sales and marketing including participating in RFP & Finalist activities, per department policies

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor of Science in Pharmacy or Doctor of Pharmacy degree
  • Active, unrestricted, US state-specific pharmacist license
  • 3 years of pharmacy practice experience or equivalent
  • Basic competency in Microsoft Word, Excel, PowerPoint, Teams and Outlook

Preferred Qualifications:

  • ASHP-accredited residency in Managed Care
  • 3 years of managed care or PBM experience
  • 2 years of client facing or clinical account management experience
  • Demonstrated solid clinical and analytic background
  • Demonstrated solid presentation skills and experience
  • Proven ability to successfully manage multiple clients simultaneously
  • Proven ability and willingness to travel
  • Proven excellent written and oral communication skills
  • Proven excellent interpersonal skills
  • Demonstrates solid initiative
  • Demonstrates high achievement drive
  • Proven exhibits competent problem-solving skills
  • Proven solid history of building relationships

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.    

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.  


What UnitedHealth Group employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom