[Hiring] Behavior Analysis Utilization Management Clinical Consultant @CVS Health

Role Description

Are you a Licensed Behavior Analyst and Board Certified Behavior Analyst passionate about improving outcomes for individuals receiving ABA and behavioral health services? Join our Utilization Management team and use your clinical expertise to ensure members receive appropriate, evidence-based care while supporting quality outcomes and effective resource utilization.

• Review treatment plans, clinical documentation, and service requests for behavioral analysis and autism-related services
• Apply evidence-based clinical guidelines, policies, and professional judgment to determine medical necessity and coverage recommendations
• Evaluate and monitor services across the continuum of care to support appropriate treatment and benefit utilization
• Collaborate with providers, care teams, and internal stakeholders to facilitate optimal care and treatment outcomes
• Identify members who may benefit from additional programs, services, or care coordination resources
• Support quality improvement efforts by identifying opportunities to enhance treatment effectiveness and resource utilization
• Serve as a subject matter expert on behavioral analysis services within the utilization management process

Qualifications

• Active, unrestricted Licensed Behavior Analyst (LBA) license in Florida
• Active, unrestricted Board Certified Behavior Analyst (BCBA) certification
• 3+ years of clinical experience in behavior analysis, autism treatment, behavioral health, or a related setting
• 2+ years of experience using Microsoft Office applications (Teams, Outlook, Word, Excel)
• 1+ year of experience using electronic medical records (EMR) systems
• Strong organizational skills with the ability to prioritize multiple tasks in a fast-paced environment
• Ability to participate in rotating evening and weekend on-call coverage as required by state regulatory requirements

Requirements

• Must reside in Florida
• Ability to work Monday–Friday, 8:00 AM–5:00 PM EST

Preferred Qualifications

• Experience working within the Florida Medicaid healthcare system
• Managed Care experience
• Utilization Review or Utilization Management experience
• Claims review experience

Education

• Master's Degree in Behavior Analysis, Psychology, Education, or a related field

Benefits

• Fully remote opportunity within Florida
• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families
• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources, based on eligibility

Pay Range

The typical pay range for this role is: $29.10 - $62.32. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above.