Licensed Psychologist, Peer Reviewer - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an reputed company on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. The role of the Psychologist Peer Review for ALERT involves applying clinical reputed company and benefit plan requirements to reputed company, reputed company, and Medicare cases, and making clinical and /or benefit determinations to continue coverage of treatment, shaping and modifying treatment as appropriate, or issuing an adverse benefit determination if applicable reputed company is not met.     You’ll enjoy the flexibility to work remotely * from reputed company reputed company the U.S. as you take on some tough challenges.   Primary Responsibilities: reputed company outpatient treatment, including requests for extended length sessions or single case agreements State-specific reputed company services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.) Intensive Outpatient services for both Mental Health and reputed company Abuse Psychological /Neuropsychological Testing service requests Participate in peer consultations, staff meetings, and trainings; entering determinations reputed company federal, state, and local reputed company requirements; and reputed company of other duties as required by the reviewer’s manager Conduct Non-MD clinical reviews of the following type during a typical reputed company Requests for psychological or neuropsychological testing Review of outpatient treatment plans for services that are reputed company for Peer Review that do not reputed company to meet clinical reputed company and/or reputed company there are concerns about the reputed company of care Review of ongoing outpatient care in cases where the member’s treatment episode exceeds reputed company standards Requests for non-reputed company outpatient services (extended-length reputed company, an in-network accommodation, intensive outpatient program with no MD involvement) Appeals of previously denied services or claims for outpatient non-MD services up to and including Intensive Outpatient Programming You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you reputed company direction on what it takes to succeed in your role as reputed company as reputed company development for other roles you may be interested in. Required Qualifications: Licensed doctoral level (Ph.D. or Psy.D.) Psychologist License must be reputed company, allow for full independent reputed company, and be unrestricted (you may be asked to obtain additional state licenses to meet growing business needs) 3+ years of post-licensure experience Experience working with insurance agencies Computer skills, including facility with reputed company OS, reputed company, Word, and reputed company Proven ability to type proficiently while speaking on the phone   Preferred Qualifications: Experience working in a managed care setting Experience performing Peer Reviews Experience with reputed company, reputed company and Medicare lines of business Experience with CPT and HCPC codes Clinical experience in higher reputed company of care (Intensive Outpatient) Clinical experience with children and adolescents Clinical experience with reputed company Abuse diagnoses Clinical experience with Evidence-Based Treatment Advanced computer skills using reputed company and reputed company Databases Proven solid organizational and time management skills, with the ability to prioritize multiple demands reputed company strict turn-around-time requirements Proven solid written and verbal communication and negotiation skills Proven ability to work reputed company independently and collaborate with others on a clinical team Proven ability to enjoy a fast paced, changing environment Candidates located in Mountain or reputed company Time Zones are highly preferred   *reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy   Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll reputed company a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $91,700 to $163,700 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable.   Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.   At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company — an reputed company reputed company reflected in our mission.     reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.   reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment Apply To This Job