Psychologist Reviewer - ABA
Core
Reviewing the appropriateness of care levels for Behavioral Health services, primarily Applied Behavior Analysis (ABA), to ensure alignment with Medical Necessity Criteria.
Role type
Licensed Clinical Psychologist (Utilization Review)
Builds
Utilization management decisions for outpatient behavioral health services
Domain
Healthcare / Behavioral Health / Managed Care
Deliverable
client delivery
Required skills
Administration and interpretation of psychological test batteries, pre-certification review, concurrent review, appeals processing, clinical guidelines adherence
Preferred skills
BCBA-D certification, experience collaborating with ABA clinicians, experience in Behavioral Health/Clinical settings
Technologies
Psychological test batteries
Responsibilities
Partner with internal UR staff and external providers to ensure consistent utilization of plan benefits; Conduct pre-certification, concurrent review, and appeals of Behavioral Health OP services; Mentor Behavioral Health Care Management staff and assist in developing programs for psychological testing
Seniority
Mid-level, Licensed Professional