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Psychologist Reviewer

Centene • Remote • Posted 3 days ago

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Remote • Full-time • $84,300-$151,700/yr • Mid Level

Job Highlights

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As a Psychologist Reviewer at Centene, you will authorize, direct, and monitor care for behavioral health and substance abuse problems based on clinical information and internal criteria for medical necessity and appropriateness of care. This role involves conducting peer reviews with psychologists and licensed therapists/certified Behavior Analysts for outpatient and/or psychological testing requests, interacting with network practitioners to provide education on best practice models, and facilitating outpatient rounds. The position is remote and requires a PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field, along with a Psychologist Unrestricted License (PhD or PsyD) or Board Certified Behavior Analyst (BCBA-D) upon hire.

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

Qualifications

Required

  • 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
  • Psychologist Unrestricted License (PhD or PsyD) Upon Hire required or Board Certified Behavior Analyst (BCBA-D) BCBA-D Upon Hire required

About Centene

Centene Corporation is a leading healthcare enterprise in the United States, specializing in managed healthcare products and services primarily through Medicaid, Medicare, and commercial offerings. The company operates on a global scale, aiming to improve health outcomes for underserved populations by providing comprehensive managed care plans that include medical, behavioral, and specialty services. With a significant presence in over 30 states and strategic developments like the acquisition of WellCare Health Plans, Centene continues to grow and innovate in the healthcare industry.

Full Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

***POSITION IS REMOTE***

***CANDIDATES THAT HAVE BOTH (PsyD or PhD) AND (BCBA-D) STRONGLY PREFERRED***

Position Purpose: 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
Education/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

PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required or:
Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire required:Pay Range: $84,300.00 - $151,700.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.