Psychologist Reviewer

Centene
Louisiana, Arkansas, Kentucky, North Carolina, California
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Software EngineeringExperience: 2+ yearsEducation: phdSkills: []

Remote Psychologist Reviewers conduct peer reviews and authorize, direct, and monitor behavioral health and/or substance abuse care based on provider information and medical-necessity criteria. You’ll review outpatient services and psychological testing requests, educate network practitioners on best-practice and utilization management processes, and partner with the Medical Director to address clinical authorization questions. The role also supports ABA-focused care for youth with Autism and requires active licensure in covered states.

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Centene
Centene
2 months ago

Psychologist Reviewer

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Source: Company careers pageValidated by: Fursa AI
Last checked: 27 days agoStatus: Live

Job Summary

Remote Psychologist Reviewers conduct peer reviews and authorize, direct, and monitor behavioral health and/or substance abuse care based on provider information and medical-necessity criteria. You’ll review outpatient services and psychological testing requests, educate network practitioners on best-practice and utilization management processes, and partner with the Medical Director to address clinical authorization questions. The role also supports ABA-focused care for youth with Autism and requires active licensure in covered states.
Location: Louisiana, Arkansas, Kentucky, North Carolina, California
Workplace: Remote
Employment Type: Full time
Job Function: Software Engineering
Seniority: Mid level

Key Responsibilities

  • •Authorize, direct, and monitor care for behavioral health and/or substance abuse problems using clinical information and medical-necessity/appropriateness criteria.
  • •Conduct peer reviews with psychologists, behavioral health therapists, and/or Board Certified Behavior Analysts for outpatient services and psychological testing requests.
  • •Interact with network practitioners to educate on best-practice models and utilization management processes.
  • •Coordinate 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 reviewable services; facilitate outpatient rounds with clinical input.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kEquityLearning BudgetPaid Leave

Key Requirements

  • •PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field.
  • •2+ years behavioral health experience.
  • •Working knowledge of psychological tests, testing procedures, diagnostic evaluations, and evidence-based practices.
  • •For ABA Reviewers: working knowledge of psychological testing/evidence-based practices for individuals with Autism Spectrum Disorder.
  • •Upon hire, an active PSY psychologist unrestricted license (PhD or PsyD); BCBA/BCBA-D preferred upon hire.
Experience:2+ yearsBehavioral healthAutismApplied behavior analysis (ABA)
Education:PhD / Doctorate in Clinical Psychology, Counseling, Behavior Analysis, or related field
Licenses:PSY - Psychologist Unrestricted License
Certifications:BCBA-DBCBA

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