ABA Utilization Management Clinical Consultant

$54,101 - $116,771/Yr

CVS Health - Oklahoma City, OK

Full-time - Mid Level

Remote - Oklahoma City, OK

Health and Personal Care Retailers

About the position

The ABA Utilization Management Clinical Consultant at CVS Health is a remote position focused on applying critical thinking and clinical expertise in the field of Applied Behavior Analysis (ABA). The role involves assessing treatment plans, coordinating healthcare services, and ensuring adherence to clinical guidelines for Behavioral Health. The consultant will work collaboratively with providers and other stakeholders to facilitate optimal care and identify members at risk for poor outcomes, while also promoting the quality and effectiveness of healthcare services.

Responsibilities

• Assess appropriateness of treatment plans across levels of care using evidence-based standards.
• Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services for members.
• Gather clinical information and apply clinical criteria to render coverage decisions.
• Collaborate with providers and other parties to facilitate optimal care and treatment.
• Identify members at risk for poor outcomes and facilitate referral opportunities.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to internal and external constituents regarding utilization management.

Requirements

• Active, current, and unrestricted LBA (Licensed Behavioral Analyst) or BCBA (Board Certified Behavior Analyst) in Oklahoma.
• 3+ years of clinical practice experience in a hospital or behavioral health setting, specifically in Autism treatment and ABA therapy.
• 2+ years of experience with MS Office Suite applications (Teams, Outlook, Word, Excel).
• 1+ year of experience with electronic medical records.
• Willingness to provide on-call UM coverage for nights and weekends as required.

Nice-to-haves

• Experience working in the Oklahoma Medicaid Health system.
• Managed care experience.
• Utilization review experience.
• Claims review experience.
• Ability to multitask and adapt to a fast-paced environment.

Benefits

• Store discount
• Employee stock purchase plan
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• 401(k)
• Tuition reimbursement
• Paid time off
• Vision insurance
• Life insurance