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Job Summary This position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA)) for medical necessity including assisting members on the telephone, reviewing medical records, reviewing cases which involves contract interpretation of behavioral health diagnoses, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits to acute in-patient to out-patient office visits, especially of Applied Behavior Analysis (ABA) as appropriate for treatment within the Autism Spectrum Diagnoses (ASD).
JOB REQUIREMENTS: - Registered Nurse (RN) or Masters-level Behavioral Health Professional (LPC, LMFT, LCSW, LCPC, BCBA, RPsy) with current license to practice at the independent practice level in TX, OK, NM, MT and IL.
- 3 years clinical experience in psychiatric setting or own behavioral health practice.
- Verbal and written communication skills.
- Analytical and decision making skills.
- PC and database experience.
PREFERRED JOB REQUIREMENTS: - Utilization review experience.
- 3 years clinical experience in psychiatric setting or behavioral health practice providing and/or supervising ABA treatment.
- Experience in a school setting or working with individuals with ASD (Autism Spectrum Diagnoses)
This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. #LI-Remote
#LI-DP1
#CA
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! Pay Transparency Statement: At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
HCSC Employment Statement: We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Base Pay Range $60,300.00 - $133,400.00
Exact compensation may vary based on skills, experience, and location.
