Licensed Psychologist, Peer Reviewer - Remote (Tri-state Area)
$91,700–$163,700 year
On-siteLincoln, Nebraska, United States
Job Summary
Apply clinical criteria and benefit plan requirements to Commercial, Medicaid, and Medicare cases to make coverage determinations, continue treatment, or issue adverse decisions. Conduct non-MD clinical reviews including requests for psychological testing, outpatient treatment plan reviews, and appeals of denied services up to Intensive Outpatient Programming. Manage standard outpatient treatment, state-specific Medicaid services, and intensive outpatient services for mental health and substance abuse. Enter determinations within federal, state, and local guideline requirements while participating in peer consultations, staff meetings, and trainings. Perform duties as required by the reviewer's manager, including handling requests for extended-length sessions and single case agreements.
Required Qualifications
- Licensed doctoral level (Ph.D. or Psy.D.) Psychologist
- License must be current, allow for full independent practice, and be unrestricted
- 5+ years of post-licensure experience
- Experience completing peer reviews including psychological testing, other Children's services like CFTSS and HCBS and Mental Health and Substance Use Disorders
- Experience working with insurance agencies
- Experience working with children and adolescents
- Computer skills, including facility with Windows OS, Outlook, Word, and Excel
- Proven ability to type proficiently while speaking on the phone
- Permanent residence in the state of New York, New Jersey, or Connecticut
Desired Qualifications
- Experience working in a managed care setting
- Clinical experience with children in foster care or knowledge of NYS foster care system
- Experience with commercial, Medicaid and Medicare lines of business
- Experience with CPT and HCPC codes
- Clinical experience in higher levels of care (Intensive Outpatient)
- Clinical experience with children and adolescents
- Clinical experience with Substance Abuse diagnoses
- Clinical experience with Evidence-Based Treatment
- Advanced computer skills using Excel and Access Databases
- Demonstrated solid organizational and time management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements
- Demonstrated solid written and verbal communication and negotiation skills
- Proven ability to work well independently and collaborate with others on a clinical team
- Proven ability to enjoy a fast paced, changing environment
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