Clinical Behavioral Health Consultant

Emploi pas sur LinkedIn

🕒 il y a 8 jours

🦌 Connecticut – Distant

🦌 Connecticut – Remote

💵 $110 467 - $237 930 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

💼 Consultant

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CVS Health

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1963

⚕️ Assurance santé

🛒 Commerce de détail

🧘 Bien-être

Healthcare Insurance • Retail • Wellness

CVS Health est une entreprise américaine de premier plan dans le domaine de la santé, dédiée à l'amélioration de l'accès et de l'accessibilité financière des soins de santé. L'entreprise s'appuie sur une approche globale qui comprend les services de santé, l'assurance santé et la gestion des prestations pharmaceutiques. À travers ses filiales, telles qu'Aetna et CVS Caremark, CVS Health propose une gamme de services qui favorisent le bien-être, la gestion des maladies chroniques et une couverture abordable des médicaments prescrits. CVS Health exploite des pharmacies de proximité, fournit des services de pharmacie par correspondance et gère des programmes de médicaments spécialisés, visant à rendre les soins de santé pratiques et accessibles à tous. Animée par une mission de connecter les individus aux services de soins essentiels, CVS Health s'engage à favoriser des communautés en meilleure santé et à soutenir le bien-être de toutes les personnes.

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.

🎯 Exigences

• 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

🏖️ Avantages

• 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