Clinical Behavioral Health Consultant

CVS Health

Clinical Behavioral Health Consultant focusing on utilization and quality review for neurodevelopmental disorders. Collaborating with various clinical leaders in addressing healthcare cases and fraud.

Posted 5/27/2026full-timeRemote • Connecticut • 🇺🇸 United StatesMid-LevelSenior💰 $110,467 - $237,930 per yearWebsite

About the role

Key responsibilities & impact

Reviews and prepares cases for medical necessity review of ABA.
Provide input into medical management programs/policies that pertain to neurodevelopmental disorders.
Serves as a clinical SME supporting SIU Investigators, Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases.
Conducts clinical quality assurance audits of provider charts and review of key policies and procedures assuring consistent use of audit tools and internal policies
Consistently collaborates with Senior SIU Medical Director, Senior QA Medical Director and BH Clinical Quality Lead Director Providers 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.

Requirements

What you’ll need

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)
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.
Active and current state license(s) without encumbrances, including 5 years of post-graduate direct patient care experience.
BCBA or BCBA-D credential

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
comprehensive benefits package designed to support physical, emotional, and financial well-being

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical practiceassessmenttreatmentneurodevelopmental disordersAutismCPT codingHCPCS codingmedical record reviewclaim payment determinationABA

Soft Skills

collaborationsubject matter expertiseguidancecommunicationquality assurance

Certifications

PhDPsyDBCBABCBA-Dstate license