Psychologist Reviewer - ABA

Elevance Health•St Louis, IN

5d•Remote

About The Position

This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. 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 accommodation is granted as required by law. The Psychologist Reviewer – ABA is responsible for collaborating with providers, BCBAs and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria. Outpatient levels of care would primarily include Applied Behavior Analysis (ABA). Other levels of care could include Psychological Testing, Neuropsychological Testing, and Mental Health Support Services.

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.
Most 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.
BCBA-D is strongly preferred.
Previous experience working alongside an ABA clinician or in collaboration/partnership with ABA services.

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.