Centene Corporation · 8 hours ago

Psychologist Reviewer

Washington, DC

Full-time

Remote

Entry, Mid Level

$84K/yr - $152K/yr

2+ years exp

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Hospital & Health Care

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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

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

Performs other duties as assigned

Complies with all policies and standards

Qualification

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Clinical PsychologyBehavioral Health ExperiencePsychologist LicenseBoard Certified Behavior AnalystPsychological Testing KnowledgeDiagnostic EvaluationsEvidence Based PracticesPeer Review ConductUtilization ManagementClinical Input