PSYCHOLOGIST REVIEWER

Sunshine State Health Plan; Alaska; Remote; USD 86,000 - 155,000; Full time

Job summary

A leading health plan is seeking a clinical professional for their Medical Management team. This fully remote position requires a PhD in Clinical Psychology and experience in Behavioral Health. Responsibilities include conducting peer reviews, collaborating with practitioners, and ensuring compliance with standards. The role offers competitive pay and a comprehensive benefits package.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Qualifications

• Minimum of 2 years in Behavioral Health required.
• Strong preference for candidates with 5+ years of experience working with children.
• Unrestricted Psychologist license (PhD or PsyD) or Board Certified Behavior Analyst (BCBA or BCBA-D) required.

Responsibilities

• Conduct peer reviews with psychologists and licensed therapists.
• Collaborate with the Medical Director on clinical authorization questions.
• Respond to state, provider, and member complaints related to psychological testing.

Skills

Behavioral Health

Clinical Psychology

Diagnostic Evaluations

Evidence-based Practices

Education

PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team. Centene is a diversified, national organization offering competitive benefits, including a fresh perspective on workplace flexibility.

Position Details

• This position is fully remote with occasional travel for team meetings. Candidates must reside and be licensed in the State of Florida to be considered.

Position Purpose

Authorize, direct, and monitor care for behavioral health and substance abuse issues based on clinical information provided by providers and internal criteria for medical necessity and appropriateness of care.

Responsibilities

1. Conduct peer reviews with psychologists and licensed therapists / certified Behavior Analysts for outpatient and/or psychological testing requests.
2. Interact with network practitioners to provide education on best practice models and utilization management processes.
3. Collaborate with the Medical Director or designee to discuss clinical authorization questions and case-specific concerns.
4. Respond to state, provider, and member complaints related to psychological testing or other review-requiring services by a PhD/PsyD.
5. Facilitate outpatient rounds, offering clinical input and oversight related to outpatient services.
6. Perform other duties as assigned.
7. Ensure compliance with all policies and standards.

Education / Experience

PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field is required.

Minimum of 2 years in Behavioral Health is required.

Strong preference for candidates with 5+ years of experience working with children.

Working knowledge of psychological tests, testing procedures, diagnostic evaluations, and evidence-based practices is required.

Licensing: Unrestricted Psychologist license (PhD or PsyD) upon hire or Board Certified Behavior Analyst (BCBA or BCBA-D) upon hire.

Compensation and Benefits

Pay Range: $86,000.00 - $154,700.00 per year.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office schedules). Actual pay will be adjusted based on skills, experience, education, and other job-related factors. Total compensation may include additional incentives.

Equal Opportunity Employment

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics by law.

Applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.