Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Aetna, a CVS Health Company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.

Under the direction of the Deputy Chief Psychiatric Officer, this position will lead efforts to best support our members with neurodevelopmental disorders across the organization.  

This position is fully remote. Fully remote. Eligible candidates can live anywhere in the United States.

Expectations/Responsibilities:

• Leads a team of psychologists 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 Psychologist 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.

Required Qualifications:

• Five (5) or more years of experience in clinical practice in the assessment and treatment of neurodevelopmental disorders, including but not limited to, Autism.
• 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
• Experience in providing clinical guidance and input in the business analytic building process.
• Active and current state license without encumbrances

Preferred:

• Experience with and knowledge of CPT and HCPCS coding guidelines and principles
• Direct experience with ABA Utilization management, clinical chart reviews, and fraud/waste/ abuse investigations

Education:

• PhD or PsyD, with specialization in neurodevelopment and child and adolescent psychology
• Active and current state license without encumbrances.

Pay Range

The typical pay range for this role is:

$99,420.75 - $214,137.00

This 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.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/30/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.