Psychologist Reviewer

Elevance Health•Nashville, TN

2d•Hybrid

About The Position

The Psychologist Reviewer is a member of the LTSS leadership team and oversees behavior support services for individuals receiving LTSS and comparable populations, including older adults, adults with physical disabilities, and people of any age with intellectual or developmental disabilities. The role collaborates with Medical Directors to manage Behavior Crisis Prevention and Intervention and Stabilization Services, and oversees quality improvement initiatives concerning behavior supports and appropriate use of psychotropic medications. The position is based in Nashville, Tennessee, with a hybrid schedule requiring in-office work one to two days per week. Candidates must live within a reasonable commuting distance of an office unless an accommodation is granted as required by law.

Requirements

Ph.D. or Psy.D. in clinical or counseling psychology, and managed care experience that includes administration and interpretation of psychological test batteries, or an equivalent combination of education and experience.
Active, unrestricted license to practice as a Clinical/Counseling Psychologist.

Nice To Haves

At least two years of experience in a Behavioral Health or clinical setting.
Tennessee psychologist license and experience in Applied Behavior Analysis, or current Board Certified Behavior Analyst certification from the Behavior Analyst Certification Board, plus at least five years directing behavior support services, including at least two years serving individuals with intellectual or developmental disabilities.
Experience partnering with Integrated Support Coordination Teams.

Responsibilities

Partner with health plan LTSS and Behavioral Health leadership to develop and monitor the behavioral health support plan for identified populations.
Partner with internal utilization review staff and external Behavioral Health Providers to ensure appropriate and consistent use of plan benefits, out-of-network services, and clinical guidelines within the scope of the license.
Conduct pre-certification, concurrent review, and appeals of Behavioral Health outpatient services.
Mentor Behavioral Health Care Management staff by assisting with training, attending utilization management rounds, and serving on interdepartmental initiatives.
Assist in developing a program around psychological and neuropsychological testing.
Collaborate with Medical Directors to manage Behavior Crisis Prevention and Intervention and Stabilization Services.
Oversee quality improvement initiatives regarding behavior supports and the appropriate use of psychotropic medications.