Psychologist Reviewer Senior
Anticipated End Date:
2026-08-24Position Title:
Psychologist Reviewer SeniorJob Description:
Location: Tampa, FL, Lake Mary, FL and Miami, FL
Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.
The Psychologist Reviewer Senior is responsible for providing day-to-day guidance, support, and leadership for clinical and/or quality activities under the guidance of a Medical Director. May be responsible for supporting one or more Medical Directors in ensuring clinical integrity of broad and significant clinical programs. May perform clinical review and participate at complaint hearings.
How you will make an impact:
- Provide clinical guidance for programs.
- Serves as a resource and consultant to other areas of the company.
- Prepare and provide consumer and provider education, trainings, or presentations as needed.
- May be required to represent the company to external entities and/or serve on internal and/or external committees.
- 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, Home or Community Based Behavioral Health or Substance Abuse Treatments, Psychological Testing, Neuropsychological Testing, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, and Mental Health Support Services.
- 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 pre-certification, concurrent review, and appeals of Behavioral Health OP 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.
Minimum requirements:
- Requires Ph.D. or Psy.D in clinical/counseling psychology and minimum of 5 years of experience in a Behavioral Health/Clinical setting and managed care experience which includes 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 to practice as Clinical/Counseling Psychologist.
Preferred Skills, Capabilities and Experiences:
- BCBA-D (Board Certified Behavior Analyst–Doctoral) strongly preferred.
- Five + years’ experience conducting assessments/testing and completing clinical case reviews for individuals with Autism Spectrum Disorder (ASD) highly preferred.
- Demonstrated leadership skills preferred.
Job Level:
Non-Management ExemptWorkshift:
Job Family:
MED > Licensed/Certified Behavioral Health RolePlease be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
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