Psychologist Reviewer - North Carolina at Elevance Health

Durham, North Carolina, United States

Apply Now

Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Behavioral Health, Health InsuranceIndustries

Requirements

Ph.D. or Psy.D. in clinical/counseling psychology
Managed care experience, including experience with the administration and interpretation of psychological test batteries (or equivalent combination of education and experience)
Active unrestricted license to practice as a Clinical/Counseling Psychologist in North Carolina
Must be a licensed psychologist in North Carolina (preferably live in the state; alternate locations may be considered)
Hybrid work: in-office 1-2 days per week (unless specified as primarily virtual)

Responsibilities

Collaborate with providers and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria for outpatient services (e.g., Individual Therapy, Group Therapy, Family Therapy, Marriage/Couples Therapy, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, Mental Health Support Services, ABA Services)
Partner 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
Conduct pre-certification, concurrent review, and appeals of Behavioral Health outpatient services
Mentor Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives
Assist in developing a program around psychological and neuropsychological testing

Skills

Psychological Testing

Neuropsychological Testing

Utilization Review

Managed Care

Behavioral Health

Pre-certification

Concurrent Review

Appeals Processing

Medical Necessity Criteria

Psychosocial Rehabilitation

ABA Services

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

Land your dream remote job 3x faster with AI

Try Jobo Free