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Position Summary:
Aetna, a CVS Health Company, is recognized as one of the oldest and largest national insurers. This extensive experience positions us uniquely to support the transformation of health care. We are committed to advancing a care system that is transparent, consumer-focused, and acknowledges physicians for their clinical excellence and effective utilization of health care resources.
Reporting to the Executive Behavioral Health Medical Director, Aetna Medicaid, this role is responsible for utilization, quality, and fraud, waste, and abuse reviews for individual cases involving members across Aetna.
Expectations and Responsibilities:
• Serve as the principal utilization management reviewer for cases related to Applied Behavior Analysis (ABA).
• Provide daily support and guidance to the ABA prior authorization clinical team and health plan medical directors.
• Serve as a principal utilization management reviewer for cases related to psychological and neuropsychological testing.
• Attend and actively participate in clinical meetings with care management and utilization management teams, offering subject matter expertise on all ABA-related questions and member concerns.
• Contribute to the development and refinement of medical management programs and policies addressing neurodevelopmental disorders.
• Recommend enhancements to managed care review guidelines and clinical criteria, drawing on comprehensive knowledge of health care delivery systems, utilization methodologies, reimbursement models, and treatment protocols.
• Offer subject matter expert support for Medicaid-wide initiatives that benefit members with neurodevelopmental disorders.
• Support provider education initiatives for professionals specializing in neurodiversity, including quality assurance and issues related to fraud, waste, and abuse.
Required Qualifications:
A minimum of five (5) years of clinical experience in the assessment and treatment of neurodevelopmental disorders, including, but not limited to, Autism Spectrum Disorder.
Doctoral degree (PhD or PsyD) with a specialization in neurodevelopment and child and adolescent psychology.
Direct experience providing treatment within the autism field, such as Applied Behavior Analysis (ABA), Naturalistic Developmental Behavioral Interventions (NDBI), or Early Intensive Behavioral Intervention (EIBI).
Primary state licensure in Louisiana (LA) with the willingness and ability to obtain additional licensure as required.
Board Certified Behavior Analyst-Doctoral (BCBA-D) credential.
Preferred Qualifications:
• Demonstrated knowledge of, and experience with, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) coding guidelines and principles.
• Experience utilizing clinical expertise to review medical records and determine claim payments in alignment with company, state, federal, and industry standard coding principles and guidelines.
Education and Credentials:
Active and unrestricted state license(s) in Louisiana (LA), with a minimum of five (5) years of post-graduate direct patient care experience.
Board Certified Behavior Analyst-Doctoral (BCBA-D) credential.
Doctoral degree (PhD or PsyD) with a specialization in neurodevelopment and child and adolescent psychology.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$90,382.00 - $194,670.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Skills Required
- At least five years of clinical experience assessing and treating neurodevelopmental disorders, including autism spectrum disorder.
- Doctoral degree, PhD or PsyD, specializing in neurodevelopment and child and adolescent psychology.
- Direct autism-field treatment experience, such as ABA, NDBI, or EIBI.
- Primary unrestricted state licensure in Louisiana and willingness to obtain additional licenses as required.
- Board Certified Behavior Analyst-Doctoral (BCBA-D) credential.
- Knowledge and experience with CPT and HCPCS coding guidelines and principles.
- Experience reviewing medical records and determining claim payments using applicable coding principles and guidelines.
- Minimum five years of post-graduate direct patient care experience.
CVS Health Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about CVS Health and has not been reviewed or approved by CVS Health.
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Healthcare Strength — Health coverage includes medical, dental, and vision with HSA-eligible options, free preventive care, virtual care, and access to MinuteClinic services. Mental-health resources such as counseling support are emphasized, and coverage is often considered solid for full-time colleagues.
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Retirement Support — A dollar-for-dollar 401(k) match up to 5% after one year and an Employee Stock Purchase Plan are consistently highlighted in Total Rewards materials. Feedback suggests retirement programs are a meaningful strength within the overall package.
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Wellbeing & Lifestyle Benefits — Wellbeing offerings include up to 20 no-cost counseling sessions per issue, backup care, tuition assistance, and substantial in-store discounts, alongside broader wellness tools. These everyday perks expand value beyond base pay and can be especially meaningful for full-time schedules.
CVS Health Insights
What We Do
CVS Health is the leading health solutions company that delivers care in ways no one else can. We reach people in more ways and improve the health of communities across America through our local presence, digital channels and our nearly 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications, or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day.
