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Utilization Management Bcba Remote Jobs in Springfield, OH

CareSource

Board-Certified Behavior Analyst

Dayton, OH · On-site +1

$94K - $164K/yr

Oversee coverage determinations for ABA utilization management to ensure members receive ... Certified by the Behavior Analyst Certification Board as a BCBA-D * Licensed Behavior Analyst in ...

All JobsUtilization Management Bcba JobsUtilization Management Bcba Remote JobsUtilization Management Bcba Remote Jobs in Springfield, OH

Utilization Management Bcba Remote information

See Springfield, OH salary details

$42.8K

$80.2K

$134.2K

How much do utilization management bcba remote jobs pay per year?

As of Jul 20, 2026, the average yearly pay for utilization management bcba remote in Springfield, OH is $80,234.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,700.00 and $81,500.00 per year, depending on experience, location, and employer.

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 job?

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 typical workday look like for a Utilization Management BCBA working remotely?

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.

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Utilization Management Bcba Remote jobs near you
Board-Certified Behavior Analyst

Board-Certified Behavior Analyst

CareSource

Dayton, OH • On-site, Remote

$94K - $164K/yr

Full-time

Posted 7 days ago

CareSource rating

7.7

Company rating: 7.7 out of 10

Based on 28 frontline employees who took The Breakroom Quiz

183rd of 281 rated insurance

Job description

Job Summary:
The Board-Certified Behavior Analyst serves as the clinical lead in developing and implementing evidenced based clinical policies and practices for members with Autism and their families
Essential Functions:
  • Oversee coverage determinations for ABA utilization management to ensure members receive appropriate and medically necessary care in the most cost-effective setting
  • Conduct or assist with peer-to-peer discussions as appropriate
  • Assume key role in quality improvement initiatives, case management activities and member safety activities (i.e. incident management)
  • Help Develop specialized Care Management program for members diagnosed with Autism
  • Develop and implement training for UM and CM employees on evidence-based treatments for Autism
  • Participate in regulatory/accreditation reviews
  • Provide guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
  • Provider technical assistance to improve quality of services to members with autism and intellectual disabilities
  • Assist in the review of utilization data to identify variances in patterns, and provide feedback and education to MCP staff and providers as appropriate
  • Represent CareSource as the primary clinical liaison to members, providers and State agencies
  • Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for all programs
  • Participate in the development, implementation and revision of the clinical care standards and practice guidelines ensuring compliance with nationally accepted quality standards
  • Participate in the development, implementation and revision of the Quality Improvement Plan and corporate level quality initiatives
  • Collaborate with market/product leaders to help define market strategy
  • Community collaborative participation
  • Participate in the evaluation and investigations of cases suspected of fraud, abuse, and quality of care concerns
  • Provide cross-coverage for Behavioral Health Medical Directors and/or markets, as needed
  • Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
  • Perform any other job related instructions, as requested

Education and Experience:
  • Completion of an accredited doctoral program
  • Minimum of three (3) years of post-doctoral experience working with people with intellectual or developmental disabilities is required
  • Managed care medical review experience is preferred

Competencies, Knowledge and Skills:
  • Microsoft Word and Excel skills
  • Excellent communication skills, both written and oral
  • Ability to work well independently and within a team environment
  • Ability to create strong relationships with Providers and Members
  • High ethical standards
  • Attention to detail
  • Critical listening and systematic thinking skills
  • Ability to maintain confidentiality and act in the company's best interest
  • Ability to act with diplomacy and sensitivity to cultural diversity
  • Decision making/problem solving skills
  • Conflict resolution skills
  • Strong sense of mission and commitment of time, effort and resources to the betterment of the communities served
  • Ability to analyze healthcare data from a variety of sources to evaluate physician practice patterns
  • Leadership experience and skills

Licensure and Certification:
  • Certified by the Behavior Analyst Certification Board as a BCBA-D
  • Licensed Behavior Analyst in state of practice to meet regulatory requirements is required

Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
  • May be required to work evenings/weekends
  • May be required to travel to fulfill duties of position

Compensation Range:
$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Fostering a Collaborative Workplace Culture
  • Cultivate Partnerships
  • Develop Self and Others
  • Drive Execution
  • Influence Others
  • Pursue Personal Excellence
  • Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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