Behavioral Analysis Utilization Management Clinical Consultant

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• 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 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 (preferred) • Managed Care experience (preferred) • Utilization Review or Utilization Management experience (preferred) • Claims review experience (preferred) • Master's Degree in Behavior Analysis, Psychology, Education, or a related field

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being