Utilization Review Clinician - ABA

Position Summary:

• Manage a caseload of 73+ active members and 30+ pending cases, ensuring timely outreach, follow-up, and care coordination.
• Conduct monthly outreach to all active members at minimum once per month to assess needs, provide resources, address barriers to care, and follow up on ongoing care plans.

Key Responsibilities:

• Manage a caseload of 73+ active members and 30+ pending cases, ensuring timely outreach, follow-up, and care coordination.
• Conduct monthly outreach to all active members at minimum once per month to assess needs, provide resources, address barriers to care, and follow up on ongoing care plans.
• Support members in maintaining independent daily functioning by identifying needs, connecting members with appropriate community and healthcare resources, and monitoring progress.
• Conduct member outreach through telephone-based care management and digital care management platforms to provide ongoing support and engagement.
• Assess member needs and coordinate appropriate services, resources, referrals, and follow-up interventions to support positive health and care outcomes.
• Participate in multidisciplinary care team meetings to discuss member needs, care plans, barriers, and progress.
• Participate in and facilitate ABA rounds, contributing to case discussions, care planning, and coordination of member services.
• Maintain accurate and timely documentation of member outreach, assessments, interventions, resources provided, and follow-up activities.
• Prioritize and manage daily workload independently while balancing active caseload responsibilities, pending cases, outreach requirements, care coordination, and team meetings.
• Identify members requiring additional intervention or escalation and collaborate with appropriate care team members to address complex needs.