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Utilization Management Bcba Remote Jobs in Florida

BK Behavior

$93/hr

Dedicated BCBA Success Manager for ongoing clinical and professional support Please note: This position is currently remote. If Georgia regulations require additional in-person services in the future ...

NTT DATA Services

BPO Senior Manager

Tampa, FL · Remote

$93K/yr

Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Remote employees must adhere to all technical support procedures and protocols. * Chronic ...

NTT DATA Services

BPO Senior Manager

Tampa, FL · Remote

$93K/yr

Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Remote employees must adhere to all technical support procedures and protocols. * Chronic ...

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Utilization Management Bcba Remote information

What is a utilization management BCBA remote?

A Utilization Management BCBA (Board Certified Behavior Analyst) Remote job involves reviewing treatment plans, ensuring the appropriate use of applied behavior analysis (ABA) services, and making recommendations based on medical necessity and insurance guidelines. This role typically requires assessing clinical documentation, collaborating with providers, and supporting authorization decisions. Since it is remote, communication is conducted via phone, email, or virtual meetings. The goal is to ensure quality care while managing costs effectively.

What does a utilization management BCBA remote do?

A typical day for a remote Utilization Management BCBA involves reviewing and evaluating treatment plans, making medical necessity determinations, and documenting decisions in compliance with health plan guidelines. You will regularly communicate with healthcare providers, clinicians, and insurance representatives via email or video conferencing to clarify details or request additional information. Collaboration with a team of fellow BCBAs and utilization management staff is common, and you may participate in case discussions or staff meetings online. This role often includes working independently, managing multiple cases at once, and ensuring all documentation meets regulatory and quality standards.

What are the key skills and qualifications needed to thrive in the utilization management BCBA remote position, and why are they important?

Success as a Utilization Management BCBA (Board Certified Behavior Analyst) Remote requires active BCBA certification, experience in behavior analysis, and strong knowledge of insurance and healthcare utilization review processes. Familiarity with electronic medical record (EMR) systems, claims management software, and telehealth platforms is typically necessary. Exceptional attention to detail, problem-solving abilities, and strong written communication skills help candidates excel in remote collaboration and case review. These skills are critical for accurately assessing treatment plans, ensuring compliance, and supporting quality care delivery across remote settings.

What are the most commonly searched types of Utilization Management Bcba jobs in Florida?

The most popular types of Utilization Management Bcba jobs in Florida are:

What are popular job titles related to Utilization Management Bcba Remote jobs in Florida?

For Utilization Management Bcba Remote jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Utilization Management Bcba Remote jobs in Florida look for?

The top searched job categories for Utilization Management Bcba Remote jobs in Florida are:

What cities in Florida are hiring for Utilization Management Bcba Remote jobs?

Cities in Florida with the most Utilization Management Bcba Remote job openings:

Utilization Management Bcba Remote jobs near you
Infographic showing various Utilization Management Bcba Remote job openings in Florida as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 11% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Physician Reviewer - Utilization Management

Oscar Health

Orlando, FL • Remote

$219K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 27 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

264th of 315 rated insurance

Job description

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Hours: 8am - 5pm in your local time zone

Call rotation - 1 weekend every 16 weeks

You will report into the Associate Medical Director, Utilization Management.

Work Location: This is a remote position, open to candidates who reside in the United States. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $219,000- $ 286,902 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses.

Responsibilities:

  • Provide medical reviews that meet Oscar's stringent quality parameters.
  • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.
  • Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).
  • Use correct templates for documenting decisions during case review.
  • Meet the appropriate turn-around times for clinical reviews.
  • Receive and review escalated reviews.
  • Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Board certification as an MD or DO
  • Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
  • 6+ years of clinical practice

Bonus points:

  • Licensure in multiple Oscar states
  • 1+ years of utilization review experience in a managed care plan (health care industry)
  • BC in Cardiology, Radiation/Oncology, or Neurology
  • Experience with care management within the health insurance industry.
  • Willing and able to obtain additional state licensure as needed, with Oscar's support

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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