Clinical Psychologist BCBA-D – Aetna Behavioral Health at CVS Health

Phoenix, Arizona, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health Insurance, Behavioral HealthIndustries

Requirements

Greater Phoenix, Arizona area resident
National Board Certified Behavior Analyst-Doctoral (BCBA-D)
Unencumbered license by the Arizona Board of Psychologist Examiners to practice as a Behavior Analyst
Five years of post-graduate direct patient care experience
Five (5) or more years of experience in clinical practice in the assessment and treatment of neurodevelopmental disorders, including but not limited to, Autism
PhD or PsyD, with specialization in neurodevelopment and child and adolescent psychology
Direct experience providing treatment in the Autism space (e.g., ABA, NDBI, EIBI)
Ability to travel up to 10% for mandatory office meetings and local travel
Preferred Qualifications
Experience with and knowledge of CPT and HCPCS coding guidelines and principles
Experience using clinical expertise in reviewing medical records and making claim payment determinations according to Company, State, Federal and industry standard coding principles and guidelines
Doctoral degree (Ph.D. or equivalent) in a field related to behavior analysis

Responsibilities

Reviews and prepares cases for medical necessity review of Applied Behavior Analysis (ABA)
Provides input into medical management programs/policies that pertain to neurodevelopmental disorders
Makes recommendations for enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems, utilization methods, reimbursement methods, and treatment protocols
Serves as a clinical SME supporting SIU Investigators, Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases
Completes Fraud waste and abuse reviews in partnership with SIU
Provides SME support to enterprise-wide initiatives supporting members with neurodevelopmental disorders
Uses available resources and technology in developing evidence, supporting allegations of fraud and abuse
Researches and prepares cases for clinical and legal review
Provides day-to-day support and guidance for ABA prior authorization clinical team and the health plan medical directors
Attends and participates in clinical meetings with care management and utilization management
Provides subject matter expertise on all ABA-related questions and member issues
Supports provider education initiatives for providers with a neurodiverse specialty including quality assurance and Fraud waste and abuse issues

Skills

ABA

BCBA-D

Utilization Review

Medical Necessity Review

Fraud Waste and Abuse

SIU Support

Neurodevelopmental Disorders

Applied Behavior Analysis

Reimbursement Methods

Treatment Protocols

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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