Registered Nurse (RN) / Behavioral Health Reviewer

Role: Registered Nurse (RN) / Behavioral Health Reviewer Location: Remote USA

Mandatory:

• Minimum 2+ years of Applied Behavioral Analysis (ABA) experience
• Active US RN License OR LMHC / LCSW Certification
• Experience with Prior Authorization, Clinical Reviews, Appeals, or Behavioral Health services
• Knowledge of Medicaid/Medicare or Health Plan operations preferred

Job Responsibilities:

• Review ABA and Behavioral Health cases for medical necessity
• Handle prior authorizations and appeals
• Work with providers regarding level of care/services
• Support treatment planning and patient progress reviews
• Maintain compliance and clinical documentation

Note: Remote back-office/non-bedside role.