Psychologist Reviewer


Psychologist Reviewer – Remote (CST Hours Needed) – PS26387

United States

Medical

PS26387

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve atone of America’s leading health benefits companies and a Fortune Top 50 Company.

This position will be supporting Psych Testing Review for our Behavioral Health Medicaid business in the state of NC. Will also support SC and GA.

Responsible for collaborating with providers and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria. Outpatient levels of care include: Individual Therapy, Group Therapy, Family Therapy, Marriage/Couples Therapy, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, and Mental Health Support Services.

Primary duties may include, but are not limited to:

Partners with internal UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope of license.

Conducts pre-certification, concurrent review, and appeals of Behavioral Health OP services.

Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing.

Qualifications:

  • Requires a Ph.D. or Psy.D in clinical/counseling psychology; managed care experience, including experience with the administration and interpretation of psychological test batteries
    • Or any combination of education and experience, which would provide an equivalent background.
  • Most possess an active unrestricted license to practice as Clinical/Counseling Psychologist.
  • Must be able to obtain NC licensure (associated expenses will be reimbursed)
  • 2-5 years experience in a Behavioral Health/Clinical setting preferred.
  • Utilization Management experience highly desired.
  • Knowledge of Behavioral Health Medicaid business preferred.
  • Proficiency with Microsoft Office products required.
  • Understanding data is preferred

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. An Equal Opportunity Employer/Disability/Veteran.



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