Psychologist Reviewer - ABA
About The Position
Work location - Hybrid 1 This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work hours: Standard Business Hours, 8am-5pm Monday - Friday The Psychologist Reviewer – ABA is responsible for collaborating with providers and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria. Outpatient levels of care include: Individual Therapy, Group Therapy, Family Therapy, Marriage/Couples Therapy, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, Mental Health Support Services, Applied Behavioral Analysis, and Autism Spectrum Disorder Services. Primary duties may include, but are not limited to: Partners with internal UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope of license. Conducts pre-certification, concurrent review, and appeals of Behavioral Health OP services. Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing.
Requirements
- Requires Ph.D. or Psy.D in clinical/counseling psychology and managed care experience which includes experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background.
- Must possess an active unrestricted license to practice as Clinical/Counseling Psychologist.
Nice To Haves
- Minimum of 2 years experience in a Behavioral Health/Clinical setting preferred.
- Experience with Applied Behavioral Analysis and Autism Spectrum Disorder is strongly preferred.
Responsibilities
- Partners with internal UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope of license.
- Conducts pre-certification, concurrent review, and appeals of Behavioral Health OP services.
- Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing.
Benefits
- Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
Number of Employees
5,001-10,000 employees
