BCBA-D​/PsyD Autism Specialist Psychologist-Clinical Reviewer (Florida Licensed

Psychologist Reviewer Senior

Location:

Tampa, FL, Lake Mary, FL and Miami, FL

Hybrid 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.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

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.