Utilization Review Clinician - ABA
About the job
- Graduate of an accredited school of nursing or bachelor's degree and 2–4 years of related experience.
- For Enterprise Population Health, 2+ years providing Applied Behavioral Analysis services as a Board Certified Behavior Analyst.
- A master's degree is required for behavioral health clinicians.
- License to practice independently and/or state-required licensure, including Board Certified Behavior Analyst certification, is required.
- Behavioral health clinical knowledge and the ability to review and/or assess Applied Behavioral Analysis treatment plans are required.
- Knowledge of Applied Behavioral Analysis services and the behavioral health utilization review process is required.
- One of the following is required: Licensed Clinical Social Worker; Licensed Mental Health Counselor; Licensed Professional Counselor; Licensed Marital and Family Therapist; Licensed Mental Health Professional; Board Certified Behavior Analyst; or Registered Nurse state or compact-state licensure with Board Certified Behavior Analyst certification.
- Licensed Behavior Analyst certification is required where required by the state.
- Evaluate members’ care and health status before, during, and after Applied Behavioral Analysis services to ensure the level of care and services are medically appropriate for behavioral health and/or autism spectrum disorder needs and clinical standards.
- Perform prior authorization reviews related to behavioral health to determine medical appropriateness in accordance with Applied Behavioral Analysis regulatory guidelines and criteria.
- Analyze behavioral health member data to improve quality and appropriate utilization of services.
- Interact with behavioral health healthcare providers as appropriate to discuss the level of care and/or services provided to members receiving Applied Behavioral Analysis services.
- Provide education to members and their families regarding the Applied Behavioral Analysis and behavioral health utilization process.
- Provide feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies.
- Perform other duties as assigned.
- Comply with all policies and standards.
- Technological proficiency and managed care experience are preferred.
- Experience working with providers and healthcare teams to review care services related to Applied Behavioral Analysis services is preferred.
- Independent licensure with Applied Behavioral Analysis experience and Board Certified Behavior Analyst certification is preferred.
About the company
Centene runs government-backed health insurance plans in the United States, with Medicaid as its largest business alongside Medicare and Affordable Care Act Marketplace coverage. It is one of the largest Medicaid insurers in the country and also runs plans for people eligible for both Medicare and Medicaid, long-term care and children in foster care. States and the federal government pay Centene a set amount per member to manage care, and individuals buy its Ambetter Marketplace plans, often with federal subsidies. Centene contracts with local doctors, hospitals and pharmacies and keeps the difference between premiums and the cost of care. The company was founded in 1984 in Milwaukee and is headquartered in Clayton, Missouri.
Company Size
10,001+
Company Stage
IPO
Headquarters
Clayton, Missouri
Founded
1984
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Simplify's Take
What believers are saying
- Profits are recovering: July 2026 results lifted full-year adjusted EPS guidance above $4.80.
- Revenue keeps growing: second-quarter revenue reported in July 2026 rose nearly 10% to about $53.6 billion.
- Large employer, many paths: Centene had 59,800 employees in June 2026 across Medicaid, Medicare and Marketplace plans.
What critics are saying
- Job security is shaky: in June 2026 Centene offered buyouts to most employees after steep membership losses.
- Exchange enrollment is shrinking: Marketplace members fell from about 5.9 million in June 2025 to 3.5 million in June 2026.
- Revenue rides on Medicaid rolls: enrollment fell 5.5% in a year to 12.1 million by June 2026.
What makes Centene unique
- Government coverage is the whole business: Centene serves more than 1 in 15 Americans across all 50 states.
- It began as a safety-net plan: a former hospital bookkeeper founded it in 1984 to serve Milwaukee's low-income patients.
- It runs specialty Medicaid: its Superior HealthPlan has been Texas's sole foster care insurer since 2008.
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Benefits
Health Insurance
401(k) Retirement Plan
401(k) Company Match
Paid Vacation
Hybrid Work Options
Flexible Work Hours
Company News
Centene Corporation announced three moves in October 2026: a performance-based prior authorisation programme, a debt redemption, and a primary care expansion. Its shares are up 6.6%. The National Performance-Based Gold Card Program begins in November 2026. It aims to streamline prior authorisation for more than 160,000 eligible providers. Centene will also redeem all remaining $568.66 million of its 4.25% Notes due 2027. The move tightens its balance sheet as it works to recover margins in Medicaid and the Marketplace. Separately, its Ambetter Health Solutions unit is working with Marathon Health to expand primary care access in select Indiana and Missouri counties.
Centene chief executive officer Sarah London says most AI deployed in health care today serves "inflationary use cases," tools that raise revenue in a fee-for-service system rather than cut the cost of care. Speaking at the Fortune Most Powerful Women Summit in Santa Barbara, she said faster billing and automated paperwork don't make care cheaper. London sees a bigger opportunity in changing how care is delivered. In rural areas, AI could help community health workers triage non-acute problems locally and avoid emergency room visits. Interactive tools could also let patients make initial decisions without a clinician visit. "That's actually how you bend the cost curve," she said. Centene, a $33 billion company, serves 26 million members through Medicaid plans in 29 states, plus marketplace and Medicare Advantage coverage.
Centene shares rose 3.5% in afternoon trading after the health coverage company said it will launch a National Performance-Based Gold Card Program in November 2026. The stock closed at $68.88, up 2.8%. The programme will streamline prior authorisation reviews for select outpatient services. More than 160,000 qualifying healthcare providers nationwide will be eligible. Prior authorisation is the process by which insurers approve medical care before it is delivered. Centene is up 64.9% since the start of the year and close to its 52-week high of $69.41, set in September 2026.
Ambetter Health Solutions and Marathon Health expand access to primary care for members in Indiana and Missouri. Oct 07, 2026, 07:00 ET The new partnership will provide eligible members with $0 primary care visits, lab services, and virtual care beginning in 2027 ST. LOUIS, Oct. 7, 2026 /PRNewswire/ - Centene Corporation (NYSE: CNC), through Ambetter Health Solutions, today announced a new collaboration with Marathon Health, a leading advanced primary care provider, designed to make primary care easier to access for Ambetter members in select counties across Indiana and Missouri. Available through CHOICE Arrangements (formerly ICHRA), eligible members will have access to $0 primary care visits and lab services, along with virtual primary care through Marathon Health. "Strong primary care can help identify health concerns earlier and give Ambetter's CHOICE members the support they need to manage their health over time," said Alan Silver, President of Ambetter Health Solutions. "By combining the flexibility of CHOICE Arrangements with Marathon Health's advanced primary care model, we're making it easier for employers to offer meaningful healthcare access while helping members get the preventive care, chronic condition support and ongoing provider relationships that can improve long-term health outcomes." Marathon Health's advanced primary care model brings together in-person and virtual care with services such as lab testing, chronic condition support, mental health services, and help navigating the healthcare ecosystem. This coordinated approach is designed to provide a simpler member experience and help address health needs before they become severe. By building trust and delivering care earlier, Marathon's model has demonstrated measurable impact among engaged members: 15% fewer emergency room visits and 41% fewer inpatient admissions. "Access to primary care shouldn't be complicated, and it shouldn't come with barriers that make people delay the care they need," said Ryan Jacobs, Senior Vice President, Strategy & Partnerships, Marathon Health. "This collaboration gives Ambetter members in Indiana and Missouri a direct path to the kind of consistent, trusted provider relationships that keep people healthier and out of high-cost care settings." Eligible members will receive information about available services and how to access care prior to the beginning of the 2027 plan year. To learn more about advanced primary care for health plans, visit Marathon Health. About Ambetter Health Solutions Ambetter Health Solutions, Centene Corporation's off-Exchange Marketplace business offering, delivers individual health insurance plans that are compatible with Individual Coverage Health Reimbursement Arrangements (ICHRA). Available in select states, including Arizona, Florida, Georgia, Ohio, Indiana, Missouri, Mississippi, Kansas, Nebraska, Oklahoma, Tennessee, Texas and South Carolina, these plans empower individuals to choose the coverage that best fits their needs, helping employers control cost while offering greater choice and flexibility to their workforce. For more information on health benefits and health insurance plans in your state, please visit the state specific link on AmbetterHealth.com. About Marathon Health Marathon Health is a leading advanced primary care provider, partnering with employer and union plan sponsors, as well as health plans, to improve health for millions of Americans. With nationwide onsite, nearsite, and network health centers, and virtual primary care, Marathon delivers a value-based model that enhances the healthcare experience for members and providers, while driving meaningful cost savings for plan sponsors. Marathon is proud to be certified as a Great Place to Work(R), reflecting the company's commitment to building an inclusive, high-trust culture where all employees can thrive. Learn more at marathon.health. SOURCE Centene Corporation
CareSource names Stephanie Williams chief financial officer. Oct 01, 2026, 15:59 ET DAYTON, Ohio, Oct. 1, 2026 /PRNewswire/ - CareSource, a nationally recognized nonprofit managed care organization, has appointed Stephanie Williams as its new chief financial officer. She succeeds Larry Smart, who will be retiring after serving as the organization's CFO for 6 years. In her new role, Williams will lead CareSource's financial strategy with a focus on long-term growth, operational performance and disciplined investment. Her leadership will support the financial functions that advance CareSource's mission and strengthen its ability to support state partners and serve members in an evolving healthcare environment. "Stephanie understands our business, our mission and the responsibility we have to the members who count on us," said Erhardt Preitauer, president and CEO, CareSource. "Her steady leadership and financial discipline will help us stay focused on what matters most: keeping CareSource strong so we can continue to improve the health and well-being of our members." Williams joined CareSource in 2021 as senior vice president and chief actuary, bringing deep experience in financial planning, actuarial strategy and health plan operations. In that role, she led financial planning across CareSource's 12 states and oversaw key Marketplace, Medicare and Medicaid rate strategy. Rylan Austin will succeed Williams as senior vice president and chief actuary, ensuring continued leadership of CareSource's actuarial strategy. Since joining CareSource in 2022, Austin has helped shape the organization's Medicaid rate advocacy and risk strategy through his expertise in analytics, forecasting, contracting and regulatory analysis. "CareSource has grown significantly since I joined, but what has remained constant is our commitment to the members and communities we serve," said Stephanie Williams, chief financial officer. "My focus is on protecting the strong foundation we've built while thoughtfully investing in our plans, our people and our future." Before joining CareSource, Stephanie served as vice president, Medicaid actuarial services lead at Centene Corporation. Prior to that, she was vice president and Medicaid chief financial officer at WellCare Health Plans. Williams is a Fellow of the Society of Actuaries, a Member of the American Academy of Actuaries and a board member at United Church Homes. About CareSource CareSource is a nonprofit, nationally recognized managed care organization with over two million members. CareSource administers one of the largest Medicaid managed care plans in the U.S. The organization offers health insurance, including Medicaid, Health Insurance Marketplace and Medicare products. As a mission-driven organization, CareSource is transforming health care with innovative programs that address the social drivers of health, prevention and access to care. SOURCE CareSource