Psychologist Reviewer

Centene
California
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 2+ yearsEducation: phdSkills: ["Collaboration","Clinical excellence"]

Review and authorize behavioral health and/or substance abuse care using clinical information from providers and medical necessity criteria. Conduct peer reviews for outpatient services and psychological testing requests, and collaborate with network practitioners to guide best-practice and utilization management processes. Partner with the Medical Director on authorization questions, respond to state/provider/member complaints, and provide clinical input during outpatient rounds. Requires a California unrestricted psychologist license and ABA-focused expertise for Autism care.

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Centene
Centene
1 month ago

Psychologist Reviewer

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Source: Company careers pageValidated by: Fursa AI
Last checked: 16 days agoStatus: Live

Job Summary

Review and authorize behavioral health and/or substance abuse care using clinical information from providers and medical necessity criteria. Conduct peer reviews for outpatient services and psychological testing requests, and collaborate with network practitioners to guide best-practice and utilization management processes. Partner with the Medical Director on authorization questions, respond to state/provider/member complaints, and provide clinical input during outpatient rounds. Requires a California unrestricted psychologist license and ABA-focused expertise for Autism care.
Location: California
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Authorize, direct, and monitor behavioral health and/or substance abuse care based on provider clinical information and medical necessity criteria
  • •Conduct peer reviews with psychologists, behavioral health therapists, and/or BCBA for outpatient services and psychological testing requests
  • •Educate network practitioners on best practice models and utilization management processes
  • •Coordinate with the Medical Director (or designee) on clinical authorization questions and case concerns
  • •Respond to state, provider, and member complaints related to psychological testing or other services requiring PhD/PsyD review, and facilitate outpatient rounds with clinical oversight

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field
  • •2+ years of Behavioral Health experience
  • •Working knowledge of psychological tests, testing procedures, diagnostic evaluations, and evidence-based practices
  • •Active, unrestricted California Psychologist license upon hire (PhD or PsyD)
  • •For ABA Reviewers: working knowledge of the same assessment areas for individuals with Autism Spectrum Disorder
Experience:2+ yearsBehavioral health
Education:PhD / Doctorate in Clinical Psychology, Counseling, Behavior Analysis (or related field)
Skills:CollaborationClinical excellence
Licenses:California Psychologist Unrestricted License
Certifications:BCBABCBA-D

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn