Behavioral Analysis Utilization Management Clinical Consultant-FLORIDA

Miami Neuroscience Institute Baptist Health South Florida; United States; Remote; USD 83,383,000 - 178,573,000; Full time

Job summary

CVS Health is hiring a Behavior Analysis Utilization Management Clinician (LBA/BCBA) for a fully remote role focused on ABA and behavioral health services. Florida residency is required, with standard hours Monday–Friday 8:00 AM–5:00 PM EST.

The role emphasizes medical necessity, treatment optimization, and collaboration with care teams. The candidate will review treatment plans, apply guidelines, and monitor services while supporting quality outcomes and efficient resource use.

Qualifications

• Active, unrestricted LBA license in Florida.
• Active, unrestricted BCBA certification.
• 3+ years of clinical experience in behavior analysis or related field.
• 2+ years of MS Office experience (Teams, Outlook, Word, Excel).
• 1+ year of EMR experience.
• Florida residency required.

Responsibilities

• Review treatment plans, documentation, and service requests for ABA and autism-related services.
• Apply evidence-based guidelines to determine medical necessity and coverage recommendations.
• Evaluate and monitor services across care continuum to support appropriate treatment and resource use.
• Collaborate with providers and care teams to facilitate optimal care.
• Identify members who may benefit from additional programs or care coordination.
• Support quality improvement efforts to enhance treatment effectiveness.
• Serve as subject matter expert on behavioral analysis in utilization management.

Skills

LBA license

BCBA certification

MS Office proficiency

EMR systems experience

Education

Florida LBA license

BCBA certification

Master's degree in Behavior Analysis or related field

Tools

Microsoft Office (Teams/Outlook/Word/Excel)

EMR systems

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

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.

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

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.

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.

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.