Psychologist Reviewer Senior
Core
Provide clinical guidance, support, and leadership for behavioral health clinical and quality activities, ensuring clinical integrity and appropriateness of care levels.
Role type
Senior Licensed/Certified Behavioral Health Role (Psychologist Reviewer)
Builds
Behavioral health utilization management programs and clinical review processes
Domain
Healthcare / Behavioral Health / Managed Care
Deliverable
client delivery
Required skills
Clinical/counseling psychology expertise, active unrestricted license to practice, administration and interpretation of psychological test batteries, pre-certification and concurrent review, appeals handling, collaboration with providers and Medical Directors, mentorship of care management staff
Preferred skills
BCBA-D certification, experience conducting assessments for Autism Spectrum Disorder (ASD), demonstrated leadership skills
Technologies
Psychological test batteries, utilization management systems
Responsibilities
Conduct pre-certification, concurrent review, and appeals of Behavioral Health Outpatient services; determine appropriateness of level of care based on Medical Necessity Criteria; serve as a resource and consultant to other areas; prepare and provide consumer and provider education and trainings; represent the company to external entities; mentor Behavioral Health Care Management staff
Seniority
Senior, hands-on IC with leadership responsibilities