Behavioral Analysis Utilization Management Clinical Consultant

This is a fully remote position, open to applicants in Florida.

📋 Description

• Assess treatment plans, clinical documentation, and service requests pertaining to behavioral analysis and autism-related services.

• Utilize evidence-based clinical guidelines, policies, and professional judgment to evaluate medical necessity and make coverage recommendations.

• Review and oversee services throughout the continuum of care to ensure appropriate treatment and benefit utilization.

• Collaborate with providers, care teams, and internal stakeholders to promote optimal care and positive treatment outcomes.

• Identify members who may gain from additional programs, services, or care coordination resources.

• Contribute to quality improvement initiatives by spotting opportunities to improve treatment efficacy and resource use.

• Act as a subject matter expert on behavioral analysis services within the utilization management framework.

⛳️ Requirements

• Must be a resident of Florida.

• Hold an active, unrestricted Licensed Behavior Analyst (LBA) license in Florida.

• Possess an active, unrestricted Board Certified Behavior Analyst (BCBA) certification.

• Have 3+ years of clinical experience in behavior analysis, autism treatment, behavioral health, or a related field.

• Have 2+ years of experience with Microsoft Office applications (Teams, Outlook, Word, Excel).

• Have 1+ year of experience using electronic medical records (EMR) systems.

• Availability to work Monday–Friday, 8:00 AM–5:00 PM EST.

• Strong organizational skills with the capability to prioritize multiple tasks in a dynamic environment.

• Willingness to participate in rotating evening and weekend on-call coverage as mandated by state regulations.

• Experience within the Florida Medicaid healthcare system (preferred).

• Managed Care experience (preferred).

• Background in Utilization Review or Utilization Management (preferred).

• Experience with claims review (preferred).

• A Master's Degree in Behavior Analysis, Psychology, Education, or a related discipline.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources promoting physical, emotional, and financial well-being.