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CVS Health Utilization Management Clinical Consultant in Houston, Texas

Job Description

ABA UM Clinical ConsultantSchedule is Monday-Friday, standard business hours 8:00am-5:00pm CST with flexibility to work outside of the standard schedule based on business needs. This is a fully remote position. Candidates may reside anywhere, but must work the required hours and be licensed in the State in which they reside; Master's Level of Education resulting in Independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP, LBA).Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care and clinical practice guidelines for Behavioral Health, specific to ABA. Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence based standards and practice guidelines to treatment where appropriate.Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.Coordinates with providers and other parties to facilitate optimal care/treatment.Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

Required Qualifications

  • Licensed Independent Behavioral Health Clinician (LCSW, LPCC, LMFT, LPAT, LP, LBA).- 3+ years direct clinical practice experience.- 1+ year Autism treatment/ABA experience.- 1+ year proficiency with computer skills which includes navigating multiple systems and keyboarding.

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

  • Independent BCBA/LBA strongly preferred.- Managed care/utilization review experience.- Case management experience.- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment.


Master's Level of Education resulting in Independent Behavioral Health licensure (LCSW, LPCC, LMFT, LPAT, LP, or LBA).

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.