Centene Corporation · 6 hours ago

Psychologist Reviewer

North Carolina, United States

Full-time

Remote

Entry, Mid Level

$84K/yr - $152K/yr

2+ years exp

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Responsibilities

Authorize, direct and monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care

Conduct peer reviews with psychologist and licensed therapist/certified Behavior Analyst for outpatient and/or psychological testing requests

Interact with network practitioners to provide education on best practice models and utilization management processes

Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases

Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD

Analyze outlier patterns of treatment among providers

Discuss analysis overview with providers with focus of changing behaviors

Follow up of meetings with providers and facility

Collaborate with Community Providers and BH OP facilities across multiple states/health plans

Facilitate outpatient rounds offering clinical input and oversight related to outpatient services

Performs other duties as assigned

Complies with all policies and standards

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Clinical PsychologyBehavioral Health experiencePsychologist Unrestricted LicenseBoard Certified Behavior AnalystPsychological testing knowledgeDiagnostic evaluationsEvidence-based practicesCollaboration with providersClinical input