Conducting prior authorization reviews for Applied Behavior Analysis (ABA) treatment services, the full-time Licensed Utilization Review Clinician will evaluate clinical documentation for medical necessity and ensure compliance with established clinical guidelines while working remotely. Key responsibilities: Evaluate member care and health status related to ABA services to ensure medical appropriateness Perform prior authorization reviews to determine medical necessity in accordance with ABA guidelines Interact with behavioral health providers to discuss care levels and provide education to members and families regarding the ABA utilization process Required qualifications: Graduate of an accredited school of nursing or a bachelor's degree with 2-4 years of related experience License to practice independently or state-required licensure (e.g., BCBA, LCSW, LMHC) Strong knowledge of medical necessity criteria and utilization management principles Experience with ABA treatment and clinical documentation review Behavioral health clinical knowledge and ability to assess ABA treatment plans