Psychologist

• Review community-based and children and family services in alignment with best-practice standards, including NCQA standards, and state regulatory requirements
• Review cases across multiple sites and levels of care to determine medical necessity
• Conduct peer reviews involving disputed levels of care
• Consult on quality of care, clinical decisions, case formulations, safety concerns, and appropriate levels of care
• Collaborate with providers and system stakeholders on member placement, response to treatment, care coordination, quality concerns, and related challenges
• Participate in quality reviews involving member complaints, grievances, and Government reviews
• Represent the medical affairs and clinical functions in clinical and administrative meetings, as required
• Participate in training and education for care managers, providers, and other internal and external stakeholders
• Communicate with providers regarding clinical and administrative matters
• Support a multidisciplinary approach through consultation with clinical, medical affairs, network development, performance evaluation, and program integrity functions
• Serve as a subject-matter expert for internal and external initiatives
• Perform other duties as assigned

Explore Psychologist Advisor at TeleSolv Consulting. Review requirements and application details.