Psychologist Reviewer Senior

Elevance Health•Tampa, FL

2d•Hybrid

About The Position

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges. The Psychologist Reviewer Senior is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors 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.
Must possess an active unrestricted license to practice as Clinical/Counseling Psychologist.

Nice To Haves

BCBA-D (Board Certified Behavior Analyst–Doctoral) strongly preferred.
Five + years’ experience conducting assessments/testing and completing clinical case reviews for individuals with Autism Spectrum Disorder (ASD) highly preferred.
Demonstrated leadership skills preferred.

Responsibilities

Provide clinical guidance for programs.
Serves as a resource and consultant to 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.
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.