Anthem, Inc. Psychologist Reviewer - Virginia Medicaid in Reno, Nevada
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.
The preferred location for this role is our Richmond, VA office.
This position will be supporting Psych Testing Reviews for our Behavioral Health Medicaid business in the state of VA.
The Psychologist Reviewer is responsible for collaborating with providers and Medical Directors to determine appropriateness of level of care based on Medical Necessity Criteria. 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 UR staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope of license.
Conducts secondary reviews and appeals of community mental health services .
Mentors Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing.
Requires a Ph.D. or Psy.D in clinical/counseling psychology; managed care experience, including experience with the administration and interpretation of psychological test batteries; or any combination of education and experience, which would provide an equivalent background.
Must possess an active, unrestricted license in the state of Virginia to practice as a Clinical/Counseling Psychologist.
Knowledge of Virginia health systems/providers highly preferred.
Experience in a Behavioral Health/Clinical setting preferred.
Experience working with community resources preferred.
Knowledge of the Medicaid appeals process a plus.
Excellent verbal and written skills.
Ability to collaborate with an Interdisciplinary Team.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.