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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

This is a full-time, remote role. Looking for someone located in any state within the Central(CST), Mountain (MST) , Pacific (PST), or Arizona time zones.

• Utilize clinical experience and skills in a collaborative process to assess appropriateness of treatment plans for Applied Behavior Analysis (ABA) services and applies evidence based standards and practice guidelines to treatment where appropriate.
• Coordinate, monitor, and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Provide triage and crisis support.
• Gather clinical information and applies the appropriate clinical criteria/guidelines, policy, procedure, and clinical judgment to render coverage.
• Gives providers determinations/recommendations along the continuum of care facilitates including effective discharge planning.
• Coordinate with providers and other parties to facilitate optimal care/treatment.
• Identify members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services, and/or programs.
• Outreach members to provide resources and education, answer questions, and offer referrals for additional services covered by the member's plan.
• Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consult and lend expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

• 3 years of direct clinical practice experience post master's degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• 2 years of crisis intervention experience
• 3 years of experience working with clients with an Autism Diagnosis
• Valid unrestricted independent professional behavioral health clinical license to practice per state regulations in the state they reside in/ one or more or equivalent is required: LBS, LBA, LPC, LMFT, LCSW, LCPC, LMHC, LCMHC, LICSW, LISW, Clinical Psychologist.
• Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service.

• Previous Managed Care experience