Utilization Review Clinician - ABA

About the role

The Utilization Review Clinician – ABA evaluates the medical appropriateness of Applied Behavioral Analysis services for members with behavioral health or autism spectrum disorder needs. This fully remote position works Monday‑Friday, 8:00 AM‑5:00 PM Eastern or Central Time.

Key responsibilities

• Review member care before, during, and after ABA services to ensure clinical appropriateness and compliance with regulatory guidelines.
• Conduct prior‑authorization reviews for behavioral health services and assess ABA treatment plans.
• Analyze member data to improve utilization quality and identify opportunities for process improvement.
• Communicate with behavioral health providers to discuss level of care and service decisions.
• Educate members and families about the ABA utilization process.
• Provide feedback to leadership on policy and process enhancements.
• Perform additional duties as assigned while adhering to company policies.

Required profile

• Active BCBA certification.
• One of the following licenses or certifications: LCSW, LMHC, LPC, LMFT, LMHP, or RN with appropriate state licensure.
• Bachelor’s degree (or graduate of an accredited nursing school) with 2‑4 years of related experience; 2+ years providing ABA services is preferred.
• Master’s degree for behavioral health clinicians is required.
• Strong knowledge of ABA services, behavioral health utilization review, and clinical standards.

Required skills

• Proficient computer skills.
• Experience with auditing and quality‑assurance processes.
• Excellent written and verbal communication.