Psychologist Reviewer at Sunshine State Health Plan

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 Purpose: Authorize, direct and monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care

• Conduct peer reviews with psychologist and licensed therapist/certified Behavior Analyst for outpatient and/or psychological testing requests
• Interact with network practitioners to provide education on best practice models and utilization management processes
• Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases
• Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD
• Facilitate outpatient rounds offering clinical input and oversight related to outpatient services
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:
PhD Clinical Psychology, Counseling, Behavior Analysis, or related field is required.

2+ years Behavioral Health is required.

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

PSY - Psychologist Unrestricted License (PhD or PsyD) upon hire is required or
Board Certified Behavior Analyst (BCBA)

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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