Clinical Psychologist BCBA/BCBA-D Behavioral Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Psychologist – Behavioral Health 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 Lead Clinical Psychologist, this position will focus on utilization, quality and fraud waste and abuse review for individual cases for members across Aetna Expectations/Responsibilities: 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. Completion of Fraud waste and abuse reviews in partnership with SIU 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 . ...