Psychologist Reviewer Senior - ABA

Elevance Health•St. Louis, MO

7d•$107,280 - $185,058•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. The Psychologist Reviewer Senior – ABA is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of our Director of Behavioral Health Psychology Services. May be responsible for supporting our health plans in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review and participate at complaint hearings.

Requirements

Requires Ph.D. or Psy.D in clinical/counseling psychology and minimum of 5 years of experience in a Behavioral Health/Clinical setting 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

BCBA-D is strongly preferred.
Previous UM experience is strongly preferred.

Responsibilities

Provide clinical guidance for programs.
Serves as a resource and consultant for other areas of the company.
Prepare and provide consumer and provider education, trainings, or presentations as needed.
May be required to represent the company to external entities and/or serve on internal and/or external committees.
Responsible for collaborating with providers 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.
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.