Behavioral Analysis Utilization Management Clinical Consultant-FLORIDA
About The Position
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. Behavior Analysis Utilization Management Clinical Consultant (LBA/BCBA) 100% Remote | Florida Residents Only | Monday–Friday, 8:00 AM–5:00 PM EST 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.
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
Nice To Haves
- Experience working within the Florida Medicaid healthcare system
- Managed Care experience
- Utilization Review or Utilization Management experience
- Claims review experience
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
Benefits
- medical
- dental
- vision coverage
- paid time off
- retirement savings options
- wellness programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
