Licensed Psychologist, Peer Reviewer - Remote

Primary Responsibilities

• Standard outpatient treatment, including requests for extended length sessions or single case agreements
• State-specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
• Intensive Outpatient services for both Mental Health and Substance Abuse
• Participate in peer consultations, staff meetings, and trainings; entering determinations within federal, state, and local guideline requirements; and perform of other duties as required by the reviewer's manager
• Conduct Non-MD clinical reviews of the following type during a typical workday
• Requests for psychological or neuropsychological testing
• Review of outpatient treatment plans for services that are sent for Peer Review that do not appear to meet clinical criteria and/or when there are concerns about the quality of care
• Review of ongoing outpatient care in cases where the member's treatment episode exceeds normative standards
• Requests for non-standard outpatient services (extended-length visits, an in-network accommodation, intensive outpatient program with no MD involvement)
• Appeals of previously denied services or claims for outpatient non-MD services up to and including Intensive Outpatient Programming

Required Qualifications

• Licensed doctoral level (Ph.D. or Psy.D.) Psychologist
• License must be current, allow for full independent practice, and be unrestricted
• 3+ years of post-licensure experience
• Experience working with insurance agencies
• Computer skills, including facility with Windows OS, Outlook, Word, and Excel
• Proven ability to type proficiently while speaking on the phone

Preferred Qualifications

• Experience working in a managed care setting
• Experience performing Peer Reviews
• Experience with commercial, Medicaid and Medicare lines of business
• Experience with CPT and HCPC codes
• Clinical experience in higher levels of care (Intensive Outpatient)
• Clinical experience with children and adolescents
• Clinical experience with Substance Abuse diagnoses
• Clinical experience with Evidence-Based Treatment
• Advanced computer skills using Excel and Access Databases
• Proven solid organizational and time management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements
• Proven solid written and verbal communication and negotiation skills
• Proven ability to work well independently and collaborate with others on a clinical team
• Proven ability to enjoy a fast paced, changing environment

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution