Psychologist Reviewer

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

Serve as a Remote Psychologist Reviewer for Applied Behavior Analysis, authorizing and monitoring behavioral health and/or substance abuse care based on medical necessity. Conduct peer reviews for outpatient services and psychological testing requests, educate network practitioners on best-practice models and utilization management, and collaborate with the Medical Director to resolve authorization questions. Handle state, provider, and member complaints related to reviewed services.

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FursaFursa
Centene
Centene
1 week ago

Psychologist Reviewer

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Serve as a Remote Psychologist Reviewer for Applied Behavior Analysis, authorizing and monitoring behavioral health and/or substance abuse care based on medical necessity. Conduct peer reviews for outpatient services and psychological testing requests, educate network practitioners on best-practice models and utilization management, and collaborate with the Medical Director to resolve authorization questions. Handle state, provider, and member complaints related to reviewed services.
Location: Louisiana
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Authorize, direct, and monitor care for behavioral health and/or substance abuse problems based on provided clinical information and medical necessity criteria.
  • •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.
  • •Collaborate with the Medical Director (or designee) to discuss clinical authorization questions and concerns for specific cases.
  • •Respond to state, provider, and member complaints related to psychological testing or other reviewed services.

Pay and Benefits

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

Key Requirements

  • •PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field required.
  • •PSY - Psychologist Unrestricted License (PhD or PsyD) required upon hire.
  • •2+ years of behavioral health experience required.
  • •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.
Experience:2+ years
Education:PhD / Doctorate in Clinical Psychology, Counseling, Behavior Analysis (or related field)
Skills:Clinical excellenceCollaborationEvidence-based judgmentCommunicationCompliance
Licenses:PSY - Psychologist Unrestricted License (PhD or PsyD)
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