Behavioral Analysis Utilization Management Clinical Consultant-FLORIDA

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

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

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

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

• Master's Degree in:
  • Behavior Analysis
  • Psychology
  • Education
  • Or a related field

The typical pay range for this role is:

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. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.