Job Description

Job Description

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/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care

• Conduct peer reviews with psychologists, behavioral health therapists and/or Board Certified Behavior Analysts for outpatient services 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 required

• Behavioral Health Experience: Minimum of 2 years required.

• Post-Licensure Clinical Experience: At least 2 years strongly preferred.

• Pediatric Experience: 5+ years working with children strongly preferred.

• Clinical Knowledge:

  • Required: Working knowledge of psychological tests, testing procedures, diagnostic evaluations, and evidence-based practices.

  • For ABA Reviewers only: Must have working knowledge of psychological assessments, diagnostic tools, and evidence-based practices specifically designed for individuals with Autism Spectrum Disorder (ASD).

• PSY - Psychologist Unrestricted License (PhD or PsyD) upon hire required

• Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire preferred

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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

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