Psychologist Reviewer

Centene Corporation • Remote-NC, NC

20d • $87,700 - $157,800 • Remote

About The Position

Centene is seeking a mission-driven psychologist to review behavioral health and substance abuse care, with a focus on Applied Behavior Analysis (ABA) and autism care. The role authorizes, directs, and monitors care based on clinical information from providers and internal criteria for medical necessity and appropriateness. It is remote and requires an active psychologist license in Arkansas, Kentucky, North Carolina, or New Jersey; licenses in other states may be considered if the candidate is willing and able to obtain additional required licensure. BCBA certification is preferred.

The reviewer conducts peer reviews for outpatient services and psychological testing requests, supports network practitioners with education on best-practice models and utilization management processes, and collaborates with the Medical Director or designee on clinical authorization questions. The role also responds to state, provider, and member complaints involving psychological testing or other services requiring review by a PhD/PsyD, and facilitates outpatient rounds with clinical input and oversight. Other duties may be assigned, and the employee must comply with all policies and standards.

Requirements

• PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field.
• At least 2 years of behavioral health experience.
• Working knowledge of psychological tests and testing procedures, diagnostic evaluations, and evidence-based practices.
• For ABA reviewers: working knowledge of psychological tests and testing procedures, diagnostic evaluations, and evidence-based practices designed for individuals with Autism Spectrum Disorder.
• Unrestricted psychologist license (PhD or PsyD) required upon hire.
• Active psychologist license in Arkansas, Kentucky, North Carolina, or New Jersey; licenses in other states may be considered if the candidate is willing and able to obtain additional required licensure.

Nice To Haves

• Board Certified Behavior Analyst (BCBA) or BCBA-D certification is preferred.

Responsibilities

• Conduct peer reviews with psychologists, behavioral health therapists, and/or Board Certified Behavior Analysts for outpatient services and/or psychological testing requests.
• Interact with network practitioners to provide education on best-practice models and utilization management processes.
• Interact with the Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.
• Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD.
• Facilitate outpatient rounds, offering clinical input and oversight related to outpatient services.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K plan
• Stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work, with remote, hybrid, field, or office schedules
• Potential additional forms of incentives, subject to applicable factors and program eligibility

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Ph.D. or professional degree