Psychologist Reviewer

Elevance Health•Nashville, TN

13d•Hybrid

About The Position

The Psychologist Reviewer is a member of the LTSS leadership team and is dedicated to overseeing behavior support services provided to individuals receiving LTSS, and comparable populations (older adults, adults with physical disabilities and people of any age with intellectual or developmental disabilities). Will be responsible for collaborating with Medical Directors to manage Behavior Crisis Prevention and Intervention and Stabilization Services and to oversee Wellpoint’s quality improvement initiatives regarding behavior supports and the appropriate use of psychotropic medications in each of these populations.

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.
Licensed psychologist in the State of Tennessee with experience in Applied Behavior Analysis or possesses current Certification by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst, and has at least five (5) years’ experience directing behavior support services, including and at least two (2) years’ experience serving individuals with I/DD.
Experience in partnering with Integrated Support Coordination Teams, preferred.

Responsibilities

Partners with healthplan LTSS and BH leadership to develop and monitor Wellpoints BH support plan for identified populations.
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.