Psychologist Reviewer

Position Title: Psychologist Reviewer

Work Location: Remote (domiciled in the state of Florida)

Assignment Duration: 6 Months (potential for extension or FTE conversion based on performance)

Work Schedule: 8 am - 5 pm (Possibility for Saturday and Sunday Weekend & Holiday coverage)

Position Summary:

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

Background & Context:

• Health plan or business unit
• Team culture
• Surrounding team & key projects
• Purpose of this team
• Reason for the request
• Motivators for this need
• Any additional upcoming hiring needs?

Key Responsibilities:

• Conduct peer reviews with psychologists, behavioral health therapists and/or Board Certified Behavior Analysts for outpatient services and/or psychological testing requests
• Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care
• 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 & Experience:

• PhD Clinical Psychology, Counseling, Behavior Analysis, or related field required
• 2+ years Behavioral Health required
• Working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices. required
• For ABA Reviewers only, working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices designed for individuals with Autism Spectrum Disorder. required
• PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required
• Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire preferred