Behavioral Analysis Utilization Management Clinical Consultant-FLORIDA

4062 Aetna Resources, LLC; Town of Florida (NY); Hybrid; USD 83.383.000 - 178.573.000; Vollzeit

Zusammenfassung

4062 Aetna Resources, LLC invites applications for a fully remote Behaviour Analysis Utilization Management Clinical Consultant (LBA/BCBA). Florida residents only, Mon–Fri 8:00 AM–5:00 PM EST.

You will review treatment plans, apply guidelines, and collaborate with providers to ensure appropriate care and coverage. Requires Florida residency, active LBA license and BCBA certification, 3+ years in behavior analysis, and EMR experience.

Qualifikationen

• Must reside in Florida.
• Active, unrestricted LBA license in Florida.
• Active, unrestricted BCBA certification.
• 3+ years of clinical experience in behavior analysis or related setting.
• 2+ years of Microsoft Office experience (Teams, Outlook, Word, Excel).
• 1+ year of EMR experience.
• Ability to work Monday–Friday, 8:00 AM–5:00 PM EST.
• Strong organizational skills.
• Ability to participate in rotating evening and weekend on-call coverage as required by state regulatory requirements.

Aufgaben

• Review treatment plans, clinical documentation, and service requests for behavioral analysis and autism-related services.
• Apply evidence-based clinical guidelines and professional judgment to determine medical necessity and coverage.
• 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.
• Identify members who may benefit from additional programs or care coordination resources.
• Support quality improvement by identifying opportunities to enhance effectiveness and resource utilization.
• Serve as a subject matter expert on behavioral analysis within utilization management.

Kenntnisse

Florida LBA license

Florida BCBA certification

Clinical experience

Microsoft Office

EMR systems

Availability Mon-Fri 8-5 EST

Organizational skills

Tools

Microsoft Office Suite

EMR software

Jobbeschreibung

Behaviour Analysis Utilization Management Clinical Consultant (LBA/BCBA)

100% Remote | Florida Residents Only | Monday–Friday, 8:00 AM–5:00 PM EST

What You'll Do

• 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

WHAT YOU BRING - REQUIRED

• 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

Preferred Qualifications

• Experience working within the Florida Medicaid healthcare system
• Managed Care experience
• Utilization Review or Utilization Management experience
• Claims review experience
• Education Master's Degree in: Behavior Analysis Psychology Education Or a related field

Why Join Us?

Fully remote opportunity within Florida

Apply your ABA and behavioral health expertise in a specialized Utilization Management role

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

If you're a Florida-licensed LBA/BCBA with a passion for evidence-based care, utilization management, and improving member outcomes, we'd love to hear from you.

Anticipated Weekly Hours

40

Time Type

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. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Application Deadline

We anticipate the application window for this opening will close on: 10/24/2026

Background and Legal

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.