Licensed Psychologist, Peer Reviewer - Remote (Tri-state Area)
$91,700–$163,700 year
On-siteNashville, Tennessee, United States
Job Summary
Apply clinical criteria and benefit plan requirements to Commercial, Medicaid, and Medicare cases to make determinations on coverage, treatment modifications, or adverse decisions. Conduct non-MD clinical reviews including psychological testing requests, outpatient treatment plan audits, and appeals for services up to Intensive Outpatient Programming. Perform standard outpatient treatment reviews, state-specific Medicaid services, and intensive outpatient assessments while entering determinations within federal, state, and local guidelines. Maintain permanent residence in New York, New Jersey, or Connecticut for remote work, with a salary range of $91,700 to $163,700 annually.
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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