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Senior Manager, Behavioral Health
CVS HealthSenior Manager leading ABA service provision and overseeing medical policy in neurodevelopmental care. Collaborating with clinical teams to enhance quality care and manage organizational efforts
About the role
Key responsibilities & impact- Leads a team of PhDs who prepare and review Applied Behavior Analysis (ABA) service provision for medical necessity
- Reviews and prepares cases for medical necessity review of ABA
- Provide input into medical management programs/policies that pertain to neurodevelopmental disorders
- Responsible for overall medical policies of the unit to ensure the appropriate and most cost-effective medical care is received, and for the day-to-day management of ABA/Psychology team
- Responsible for recommending changes and 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
- Leads clinical staff in the coordination of quality care
- Provides clinical expertise and business direction in support of medical management programs through participation in clinical team activities
- Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams
- Serves as a clinical subject matter expert supporting Special Investigative Unit Investigators, Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases
- Provides clinical expertise and consultation in the creation of data analytic monitors to identify potential patterns of suspected fraud, waste, or abuse
- Providers subject matter expert 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
Requirements
What you’ll need- Five (5) or more years of experience in clinical practice in the assessment and treatment of neurodevelopmental disorders
- Five (5) or more years administrative experience in the health care industry or managed care
- PhD or PsyD, with specialization in neurodevelopment and child and adolescent psychology or behavior analysis
- Experience in providing clinical guidance and input in the business analytic building process
- Active and current BCBA or Psychology state license without encumbrances
Benefits
Comp & perks- medical, dental, and vision coverage
- paid time off
- retirement savings options
- wellness programs
- comprehensive benefits package designed to support colleagues and their families
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Applied Behavior Analysisclinical practiceassessmenttreatmentclinical guidancedata analyticsmedical necessity reviewhealth care delivery systemsutilization methodsreimbursement methods
Soft Skills
leadershipteam managementclinical expertisecommunicationcollaborationconsultationproblem-solvingbusiness directionquality care coordinationsubject matter expertise
Certifications
PhDPsyDBCBAPsychology state license