Clinical Behavioral Health Consultant

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🕒 May 27

🦌 Connecticut – Remote

🦌 Connecticut – Remote

💵 $110.5k - $237.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Reviews and prepares cases for medical necessity review of ABA. • Provide input into medical management programs/policies that pertain to neurodevelopmental disorders. • Serves as a clinical SME supporting SIU Investigators, Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases. • Conducts clinical quality assurance audits of provider charts and review of key policies and procedures assuring consistent use of audit tools and internal policies • Consistently collaborates with Senior SIU Medical Director, Senior QA Medical Director and BH Clinical Quality Lead Director Providers SME support to enterprise-wide initiatives supporting members with neurodevelopmental disorders • Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse. • Researches and prepares cases for clinical and legal review. • Provides day-to-day support and guidance for ABA prior authorization clinical team and the health plan medical directors. • Attends and participates in clinical meetings with care management and utilization management. • Provides subject matter expertise on all ABA-related questions and member issues. • Supports provider education initiatives for providers with a neurodiverse specialty including quality assurance and Fraud waste and abuse issues.

🎯 Requirements

• Five (5) or more years of experience in clinical practice in the assessment and treatment of neurodevelopmental disorders, including but not limited to, Autism. • PhD or PsyD, with specialization in neurodevelopment and child and adolescent psychology • Direct experience providing treatment in the Autism space (e.g., ABA, NDBI, EIBI) • Experience with and knowledge of CPT and HCPCS coding guidelines and principles • Experience using clinical expertise in reviewing medical records and making claim payment determinations according to Company, State, Federal and industry standard coding principles and guidelines. • Active and current state license(s) without encumbrances, including 5 years of post-graduate direct patient care experience. • BCBA or BCBA-D credential

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • comprehensive benefits package designed to support physical, emotional, and financial well-being