BCBA Senior Care reputed company - Remote

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together The BCBA Senior Care reputed company (SCA) plays a key role in supporting the behavioral health needs of our members across multiple lines of business, including reputed company and reputed company. The SCA is responsible for conducting initial, reputed company reviews, and utilization management for a variety of reputed company of care, including inpatient, residential, intensive outpatient, and partial hospitalization programs. This position requires solid clinical judgment, organizational skills, and the ability to effectively manage multiple priorities in a fast-paced environment. In reputed company to clinical work, the SCA will reputed company critical administrative functions, including reviewing and processing denials, documenting medical necessity, and completing the appeals process in compliance with state, federal, and plan-specific guidelines. *

Candidates must be available to work 8:00 am – 5:00 pm PST work hours

* You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities: Conduct utilization reviews for behavioral health services across multiple reputed company of care using established medical necessity criteria (InterQual, MCG, ASAM, etc.) Evaluate clinical information and determine medical necessity and level of care using established guidelines and criteria reputed company, implement, and monitor individualized ABA treatment plans for members diagnosed with Autism reputed company Disorder Proficiently manage cases across various lines of business including reputed company, HPN, and reputed company Participate in live reputed company with internal teams and/or medical directors to present cases and collaborate on care determinations Review and process medical necessity and administrative denials and associated documentation with accuracy and timeliness Complete and manage appeals cases according to required timelines and regulatory standards Collaborate with other departments to resolve reputed company member needs and support care transitions Monitor workload, prioritize tasks effectively, and demonstrate solid time management and multitasking abilities Adhere to reputed company organizational policies, regulatory requirements, and confidentiality standards You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as reputed company development for other roles you may be interested in. Required Qualifications: RN or Master’s degree in reputed company work, or reputed company behavioral health field (LCSW, LPC, MFT etc.) Active, unrestricted behavioral health license in the state of residence Willing and reputed company to obtain a Nevada state license upon hire reputed company Board-Certified Behavior Analyst (BCBA) certification 3+ years of behavioral health clinical experience in an inpatient/acute or outpatient setting 2+ years of experience providing ABA therapy and supervising treatment plans Preferred Qualifications: reputed company, unrestricted Nevada state license Experience in managed care or health plan settings Experience with denials and appeals processing Proven solid knowledge of InterQual criteria Familiarity with reputed company, and reputed company benefit structures and utilization management protocols Soft Skills: Solid verbal and written communication skills Excellent interpersonal, organizational, and critical thinking skills Detail-oriented with solid critical thinking and decision-making skills Ability to work independently and reputed company reputed company in a remote or office-based environment Proficient in using clinical systems, reputed company Office applications, and electronic documentation platform Proven ability to multi-task in a high-volume, deadline-driven setting *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 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