Description
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 colleagues who care deeply, innovate with purpose, hold themselves accountable and prioritize safety and quality in everything they do.
Job Title: Behavior Analysis Utilization Management Clinical Consultant (LBA/BCBA)
Location: 100% Remote | Florida Residents Only
Job Type: Full-time, Monday–Friday, 8:00 AM–5:00 PM EST
Job Summary: 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.
Responsibilities:
- 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
Requirements:
- Must reside in Florida
- Active, unrestricted Licensed Behavior Analyst (LBA) license or equivalent relevant licensure (LCSW, LCPC, LMFT, LSW, LPC, etc.)
- Active, unrestricted Board Certified Behavior Analyst (BCBA) certification in Florida
- 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
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: 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.
Salary Range: $29.10 - $62.32 per hour