Job Description

Clinical Psychologist BCBA-D – Aetna Behavioral Health Join to apply for the Clinical Psychologist BCBA-D – Aetna Behavioral Health role at CVS Health Position Summary Aetna, a CVS Health Company, is one of the oldest and largest national insurers. This position under the Lead Director, Service Operations focuses on utilization, quality, and fraud waste and abuse review for individual cases for members across Aetna. The role is fully remote and requires an Arizona license and residency in the greater Phoenix area. Expectations/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. Recommends enhancements to current managed care, review guidelines, and clinical criteria based on extensive knowledge of health care delivery systems. Serves as a clinical SME supporting SIU Investigators, Managers, and Directors in investigations of suspected healthcare fraud cases and completes fraud waste and abuse reviews in partnership with SIU. Supports enterprise-wide initiatives for members with neurodevelopmental disorders. Uses available resources and technology to develop evidence and support 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 and provides 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. Required Qualifications Greater Phoenix, Arizona area resident. National Board Certified Behavior Analyst-Doctoral (BCBA-D) and 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 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. Education Doctoral degree (Ph.D. or equivalent) in a field related to behavior analysis. Anticipated Weekly Hours 40 Time Type Full time Pay Range $100,425.00 - $216,300.00 Benefits Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. #J-18808-Ljbffr CVS Health

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