Psychologist Reviewer Senior - ABA
Core
Senior clinical reviewer providing guidance, support, and leadership for behavioral health clinical and quality activities, ensuring clinical integrity and managing care appropriateness.
Role type
Senior Licensed Behavioral Health Psychologist (Utilization Management)
Builds
Clinical review programs, care management strategies, and utilization management initiatives for health plans.
Domain
Healthcare / Behavioral Health / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical/Counseling Psychology expertise, Behavioral Health management, Psychological testing administration and interpretation, Medical necessity determination, Pre-certification and concurrent review, Appeals management, Mentorship and training
Preferred skills
BCBA-D certification, Utilization Management (UM) experience
Technologies
Psychological test batteries, Medical Necessity Criteria, Utilization Management systems
Responsibilities
Provide clinical guidance for programs; Represent the company to external entities; Collaborate with providers to determine appropriateness of level of care; Conduct pre-certification, concurrent review, and appeals of Behavioral Health services; Mentor Behavioral Health Care Management staff.
Seniority
Senior, hands-on IC with leadership responsibilities