We are partnering with North Carolina DHHS to operationalize the single, statewide Medicaid Plan designed to support Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system so that they receive seamless, integrated, and coordinated health care. Within the Children and Families Specialty Plan (CFSP), and regardless of where a member lives, they will have access to the same basic benefits and services, including: Physical health, Behavioral health, Pharmacy, Intellectual/Developmental Disabilities (I/DD) services, Long term services and supports, Unmet health-related resource needs, and Integrated care management.

We envision a North Carolina where all children and families are thriving in safe, stable, and nurturing homes. Our trauma-informed, System of Care-designed and outcomes-driven approach of CFSP to serving infants, children, adolescents, their parents and guardians, young adults, caregivers, and resource parents engaged in the North Carolina child welfare system, specifically families involved with DSS and youth in Foster Care. Our teams will work closely with providers, social workers and local stakeholders to bring families across the state comprehensive, whole-person care that addresses the full set of factors that impact health

The Psychologist Reviewer Sr 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.

Primary duties may include but are not limited to:

• 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.

Position 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.
• Most possess an active unrestricted license to practice as Clinical/Counseling Psychologist.

Position Requirements as per state contract:

• 2+ years in managed care required.

Please 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. 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 may contact elevancehealthjobssupport@elevancehealth.com for assistance.