Psychologist Reviewer Senior (Florida Licensed)

Location: Tampa, FL, Lake Mary, FL and Miami, FL Hybrid Work 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. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered unless accommodation is granted as required by law. Job Overview 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, and may perform clinical review and participate at complaint hearings. Responsibilities Provide clinical guidance for programs. Serve as a resource and consultant to other areas of the company. Prepare and provide consumer and provider education, training, or presentations as needed. Represent the company to external entities and/or serve on internal and external committees. Collaborate with providers and Medical Directors to determine the 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. Partner 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. Conduct pre‑certification, concurrent review, and appeals of Behavioral Health OP services. Mentor Behavioral Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assist in developing a program around psychological and neuropsychological testing. Minimum Requirements Requires Ph.D. or Psy.D. in clinical/counseling psychology and a 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 or more years’ experience conducting assessments/testing and completing clinical case reviews for individuals with Autism Spectrum Disorder (ASD) highly preferred. Demonstrated leadership skills preferred. Benefits We offer a range of market‑competitive total rewards that include merit increases, paid holidays, paid time off, incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long‑term disability benefits, 401(k) with match, stock purchase plan, life insurance, wellness programs, and financial education resources. 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, and local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance. 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. #J-18808-Ljbffr Elevance Health