ABA Utilization Management Clinical Consultant

Behavioral Health Specialist

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.

Position Summary:

Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to ABA.

Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards and practice guidelines to treatment where appropriate.

Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.

Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.

Coordinates with providers and other parties to facilitate optimal care/treatment.

Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.

Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications:

• Independent BCBA/LBA
• 3+ years clinical practice experience, e.g., hospital setting, direct clinical practice experience required
• 1+ years of Autism treatment/ABA experience required
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Schedule is Monday-Friday with flexibility to work outside of the standard schedule based on business needs
• This is a remote position

Preferred Qualifications:

• Managed care/utilization review experience preferred
• Independent BCBA/LBA preferred
• Case management experience preferred

Education:

• Master's Level of in Behavioral Health (for example, Psychology, Counseling, Social Worker, etc.)

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $26.01 - $56.14

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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.