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Utilization Management Bcba Remote Jobs in Florida

Oscar Health

Sr. Quality of Care Review Nurse

Miami, FL · Remote

$83K - $109K/yr

You will report into the Nurse Manager, Quality of Care. Work Location: This is a remote position ... Health plan utilization management experience or case management experience. * Experience in health ...

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Utilization Management Bcba Remote information

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 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.

Can you work fully remote as a utilization management BCBA?

Utilization management BCBA roles can often be performed remotely, especially if the employer supports telehealth and digital documentation. These positions typically require strong communication skills, certification, and familiarity with electronic health records, making remote work feasible with proper technology and supervision. However, some employers may have in-office requirements depending on company policies or client needs.

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 80% Full Time, and 20% Contract. Highlights an 100% Remote job distribution.

Care Review Clinician (RN) - Remote in FL

Molina Healthcare

Tampa, FL • Remote

$26.41 - $43/hr

Full-time

Re-posted 15 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 199 frontline employees who took The Breakroom Quiz

164th of 308 rated insurance

Job description

JOB DESCRIPTION 

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
Processes requests within required timelines. 
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
Requests additional information from members or providers as needed. 
Makes appropriate referrals to other clinical programs. 
Collaborates with multidisciplinary teams to promote the Molina care model. 
Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 
Recent hospital experience in an intensive care unit (ICU) or emergency room.

  • Utilization Management (UM) experience highly preferred. 

#PJHS3

#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $43 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

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About Molina Healthcare

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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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