Behavioral Analysis Utilization Management Clinical Consultant-FLORIDA

CVS Health; Lorida (FL); Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is seeking a Behavior Analysis Utilization Management Clinical Consultant (LBA/BCBA) for a fully remote role serving Florida residents. The position requires 3+ years of clinical experience in behavior analysis or related fields, with comfort using Microsoft Office tools and EMR systems.

Candidate will review treatment plans and apply guidelines to determine medical necessity within utilization management.

Qualifications

• 3+ years of clinical experience in behavior analysis, autism treatment, behavioral health, or a related setting.
• Experience with utilization management processes and medical necessity determinations.
• Familiarity with Florida Medicaid guidelines is a plus.

Responsibilities

• Review treatment plans, clinical documentation, and service requests for behavioral analysis and autism-related services.
• Apply evidence-based clinical guidelines to determine medical necessity and coverage recommendations.
• Evaluate and monitor services across the continuum of care to support appropriate treatment and benefit utilization.
• Support quality improvement efforts by identifying opportunities to enhance treatment effectiveness and resource utilization.
• Serve as a subject matter expert on behavioral analysis within the utilization management process.
• Collaborate with providers and multidisciplinary healthcare teams.
• Contribute to improving member outcomes and family experiences with autism and behavioral health treatment.

Skills

Clinical experience

Behavior analysis

Autism treatment

Behavioral health

Utilization management

Microsoft Office

Tools

Microsoft Office

Job description

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

• 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
• 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
• Influence quality, access, and effectiveness of behavioral health services
• Collaborate with providers and multidisciplinary healthcare teams
• Make a meaningful impact on members and families receiving autism and behavioral health treatment

Fully remote opportunity within Florida

Experience and qualification criteria include:

• 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
• ~ Ability to participate in rotating evening and weekend on-call coverage as required by state regulatory requirementsExperience working within the Florida Medicaid healthcare system
• Managed Care experience
• Utilization Review or Utilization Management experience
• Claims review experience
• Behavior Analysis
• Psychology
• Or a related field

Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.

• medical
• dental
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility

We anticipate the application window for this opening will close on: 10/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.