Psychologist Reviewer - Kansas - part time

Elevance Health•Topeka, KS

8d•Remote

About The Position

The Psychologist Reviewer - Kansas - part time is responsible for collaborating with providers and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria, primarily ABA services. May be called upon to review other outpatient levels of care including: Individual Therapy, Group Therapy, Family Therapy, Marriage/Couples Therapy, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, and Mental Health Support Services. Will also serve as a subject matter expert collaborating with plan leadership, providers and other stakeholders to enhance the delivery of service for Autism Spectrum Disorder. This is a part-time role (20 hours/week) requiring the hire to be licensed and domiciled in the state of Kansas. The role is primarily virtual, with flexibility and autonomy, except for required in-person training sessions. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless accommodation is granted.

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.
Must possess an active unrestricted license to practice as Clinical/Counseling Psychologist.
Licensed and domiciled in the state of Kansas.

Nice To Haves

Minimum of 2 years experience in a Behavioral Health/Clinical setting preferred.
Previous experience working alongside an ABA clinician and/or in collaboration with ABA services is strongly preferred.

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.