Psychologist ReviewerMolina's Behavioral Health Psychologist Reviewers ensure that requests for behavioral health services meet nationally recognized medical necessity criteria. This role may also include providing subject matter expertise related to the individual's training and experience (e.g. Applied Behavior Analysis).Main duties and responsibilities of the role include:Working closely with the MHI VP of Behavioral Health and the Central Behavioral Health Team to review requests for behavioral health related services based on requisite medical necessity criteria within contractual turnaround times.Completing medical necessity reviews on requests for services commensurate with licensure.Reviewing outlier cases and providing feedback to other departments such as SIU.Working with trainers to develop and provide enterprise-wide teaching on psychiatric diagnoses and treatment.Providing second level BH clinical reviews, BH peer reviews and appeals as appropriate.Additional duties as assigned.Required education: Doctorate Degree in Clinical Psychology.Required experience/knowledge, skills and abilities:3 years experience in Utilization/Quality Program Management/Managed Care Experience.5+ years clinical practice.Current clinical knowledge of outcomes based psychological procedures and services.Knowledge of applicable state, federal and third party regulations.Required license, certification, association:Active and unrestricted State License to practice psychology (independently), free of sanctions from Medicaid or Medicare.Licensed in multiple states (or ability and willingness to obtain as business need requires).
Psychologist Reviewer- Behavioral Health in ca at Unknown Company
This position is listed as contract and onsite.