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Utilization Management Bcba Remote Jobs (NOW HIRING)

CHPW

Utilization Management Clinician I

Seattle, WA · On-site +1

$35.92 - $55.67/hr

This position is available fully remote in Washington state. Who we are Community Health Plan of ... About the Role The Level I Utilization Management Clinician performs utilization review for medical ...

Ascension

Utilization Management Coordinator

Austin, TX · Remote

$23.60 - $31.92/hr

Austin, TX - Partially Remote Facility: Ascension and Texas Administrative Office Department ... Manage core office services, including supplies, telephone coverage, and the preparation and ...

Ascension

Utilization Management Coordinator

Austin, TX · Remote

$24.87/hr

Austin, TX - Partially Remote Facility: Ascension and Texas Administrative Office Department ... Manage core office services, including supplies, telephone coverage, and the preparation and ...

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

As of Jun 8, 2026, the average yearly pay for utilization management bcba remote in the United States is $89,075.00, according to ZipRecruiter salary data. Most workers in this role earn between $74,000.00 and $90,500.00 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.

More about Utilization Management Bcba Remote jobs
What cities are hiring for Utilization Management Bcba Remote jobs? Cities with the most Utilization Management Bcba Remote job openings:
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Utilization Management Bcba Remote jobs near you
Infographic showing various Utilization Management Bcba Remote job openings in the United States as of May 2026, with employment types broken down into 10% As Needed, 50% Full Time, 20% Part Time, and 20% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $89,075 per year, or $42.8 per hour.
Medical Director, Utilization Management

Medical Director, Utilization Management

UPMC Health Plan

Pittsburgh, PA • Remote

Other

Posted 4 days ago

Job description

Purpose:
The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.

UPMC offers a premier benefits package, designed to care for your total well-being - physically, emotionally, and financially - paired with endless opportunities for career advancement and growth. Discover the culture, the teams, and the passions that drive us to make Life Changing Medicine happen.


Responsibilities:

  • Provide leadership direction for provider credentialing processes.
  • Physicians must devote sufficient time to the CHC-MCO to provide timely medical decisions, including after-hours consultation, as needed
  • Provide leadership and direction in meeting Quality Improvement and Care Management goals directed at improvements in member health status outcomes and established business strategies.
  • Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
  • Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns.
  • Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management.
  • Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes.
  • Responsible for reporting the communication of reportable communicable diseases in accordance with statute.
  • Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures.
  • Work with the DOH State and District Office Epidemiologists in partnership with the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. Code 27.1 et seq.
  • Daily interventions support implementation of the Health Plan's Quality Improvement and Care Management Programs.
  • Represent the Health Plan in external accreditation and certification activities.
  • Act as first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments.
  • Daily activities support adherence to quality and utilization standards, and establish an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school Required
  • The ideal candidates will have a minimum of 5-10 years of clinical experience
  • Managed Care experience preferred
  • Preference will be given to candidates with board certification in Internal Medicine, Family Medicine, Geriatric Medicine or Emergency Medicine
    Licensure, Certifications, and Clearances:
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

  • PA Medical License

UPMC is an Equal Opportunity Employer/Disability/Veteran

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