• Psychologist Reviewer

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5271
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Psychologist Reviewer is responsible for collaborating with providers, clinical staff, and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria. Child and Adult outpatient levels of care include: Individual Therapy, Group Therapy, Family Therapy, Marriage/Couples Therapy, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, and Mental Health Support Services. Primary duties may include, but are not limited to: Partners with internal behavioral health and addiction recovery treatment utilization reviewers, care coordination staff, contracting, and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines. Conducts pre-certification, concurrent reviews, and appeals of Behavioral Health services. Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiative

    Responsibilities

    • Assisting the Associate Vice President of Behavioral Health and Behavioral Health Medical Director in the following activities:
      • Behavioral Health Utilization Management
      • Behavioral Health Quality Assessment and Improvement activities
      • Outreach programs and developing partnership opportunities
      • Development of practice and preventive guidelines
      • Ensuring regulatory and accreditation compliance
      • Serving as a Virginia Premier representative in designated local meetings with leadership, provider offices, local and state health care organizations
      • Monitoring of provider performance
      • Recommending departmental improvements
    • Resource for Health Services staff for care coordination and management of behavioral health services
    • Acting as a behavioral health expert for peer to peer reviews and for case reviews
    • Internal expert on Community Mental Health and Rehabilitation Services
    • Internal expert on Addiction Recovery Treatment Services and the ASAM Levels of Care
    • Demonstrating collaboration with Virginia Premier staff and management to achieve goals and objectives of the department and organization

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Active unrestricted license to practice in Virginia as Clinical/Counseling Psychologist
    • Ph.D. or Psy.D in clinical/counseling psychology

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Understanding of CMHRS and ARTs services in Virginia
    • Familiar with DMAS Manuals and Medical Necessity Criteria of Behavioral Health Services.
    • Commitment to Virginia Premier’s clinical programs and mission to serve the Medicaid population
    • Ability to work with colleagues and other health care professionals to resolve utilization and quality management issues
    • Ability to communicate effectively with health professionals, administrators and staff, both orally and in writing
    • Strong Computer Skills

    WORK BACKGROUND/EXPERIENCE

    • Minimum of 5 years clinical experience
    • Managed care experience, including experience with the administration and interpretation of psychological test batteries.
    • 2-5 years of clinical experience in a Behavioral Health and Addiction Recovery Treatment.

    PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position.

     

    Equal Opportunity Employer All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

     

    Our mission is to inspire healthy living within the communities we serve!

     

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