Psychologist Reviewer

Location

Nashville, TN — Hybrid. This role requires associates to be in-office 1–2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

About the Role

The Psychologist Reviewer is a member of the LTSS leadership team and is dedicated to overseeing behavior support services provided to individuals receiving LTSS, and comparable populations (older adults, adults with physical disabilities and people of any age with intellectual or developmental disabilities). Will be responsible for collaborating with Medical Directors to manage Behavior Crisis Prevention and Intervention and Stabilization Services and to oversee Wellpoint's quality improvement initiatives regarding behavior supports and the appropriate use of psychotropic medications in each of these populations.

How You Will Make An Impact

• Partners with healthplan LTSS and BH leadership to develop and monitor Wellpoint's BH support plan for identified populations.
• 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.

Minimum Requirements

• Requires Ph.D. or Psy.D in clinical/counseling psychology and managed care experience which includes experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background.
• Must possess an active unrestricted license to practice as Clinical/Counseling Psychologist.

Preferred Skills, Capabilities And Experiences

• Minimum of 2 years experience in a Behavioral Health/Clinical setting preferred.
• Licensed psychologist in the State of Tennessee with experience in Applied Behavior Analysis or possesses current Certification by the Behavior Analyst Certification Board as a Board Certified Behavior Analyst, and has at least five (5) years' experience directing behavior support services, including and at least two (2) years' experience serving individuals with I/DD.
• Experience in partnering with Integrated Support Coordination Teams, preferred.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

Benefits

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Workforce Strategy

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.