Anticipated End Date:2026-08-24
Position Title:Psychologist Reviewer Senior
Job Description:Psychologist Reviewer SeniorLocation: Tampa, FL, Lake Mary, FL and Miami, FLHybrid 1: 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 an accommodation is granted as required by law.
The
Psychologist Reviewer Senior is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review and participate at complaint hearings.
How you will make an impact: - Provide clinical guidance for programs.
- Serves as a resource and consultant to other areas of the company.
- Prepare and provide consumer and provider education, trainings, or presentations as needed.
- May be required to represent the company to external entities and/or serve on internal and/or external committees.
- 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, Home or Community Based Behavioral Health or Substance Abuse Treatments, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, and Mental Health Support Services.
- 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 minimum of 5 years of experience in a Behavioral Health/Clinical setting 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:
- BCBA-D (Board Certified Behavior Analyst-Doctoral) strongly preferred.
- Five + years' experience conducting assessments/testing and completing clinical case reviews for individuals with Autism Spectrum Disorder (ASD) highly preferred.
- Demonstrated leadership skills preferred.
Job Level:Non-Management Exempt
Workshift:Job Family:MED > Licensed/Certified Behavioral Health Role
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
