Remote LBA/BCBA Utilization Consultant

CVS Health; United States; Remote; USD 61,000 - 130,000; Full time

Benefits offered by this job

Remote work within Florida

Comprehensive benefits package

Job summary

CVS Health is seeking a Behavior Analysis Utilization Management Clinical Consultant (LBA/BCBA) for a 100% remote Florida role. You will review plans, determine medical necessity, and collaborate with care teams to optimize behavioral health services for members.

Ideal candidates hold an LBA license in Florida, BCBA certification, and 3+ years of relevant clinical experience, with strong MS Office and EMR proficiency.

Qualifications

• 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.

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.

Skills

Excellent communication

Organizational skills

Team collaboration

MS Office proficiency

Education

Master's degree in Behavior Analysis/ Psychology/ Education/ Related field

Licensed Behavior Analyst (LBA) license in Florida

Board Certified Behavior Analyst (BCBA) certification

Tools

EMR systems

Microsoft Office (Teams, Outlook, Word, Excel)

Job description

CVS Health is seeking a Behavior Analysis Utilization Management Clinical Consultant (LBA/BCBA) for a 100% remote Florida role. You will review plans, determine medical necessity, and collaborate with care teams to optimize behavioral health services for members.

Ideal candidates hold an LBA license in Florida, BCBA certification, and 3+ years of relevant clinical experience, with strong MS Office and EMR proficiency.