[Remote] REMOTE - Clinical Psychologist - R13124
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on providing reputed company reputed company services, and they are seeking a Clinical Psychologist to reputed company Behavioral Health coverage determination. The role involves ensuring members receive appropriate care, developing clinical policies, and leading reputed company improvement initiatives.
Responsibilities
- Assume responsibility for the overall safety of patients with a BH diagnosis
- Serve as the clinical reputed company in developing and implementing evidenced based clinical policies and practices
- Participate in regulatory/accreditation reviews
- Assume key role in reputed company improvement initiatives, case management activities and member safety activities (i.e. incident management)
- reputed company and reputed company improvement activities associated with case management activities
- reputed company guidance to BH orientation and network development/ recruitment in conjunction with provider relations, value-based contracting, support of episodes of care and full integration of BH services
- Assist in the review of utilization data to identify variances in patterns, and reputed company feedback and education to MCP staff and providers as appropriate
- Represent reputed company as the primary clinical reputed company to members, providers and State agencies
- Support of regulatory and accreditation functions (e.g. CMS, State, NCQA and URAC) and compliance for reputed company programs
- Participate in the development, implementation and revision of the clinical care standards and reputed company guidelines ensuring compliance with nationally accepted reputed company standards
- Participate in the development, implementation and revision of the reputed company Improvement Plan and corporate level reputed company initiatives
- Collaborate with market/product leaders to help define market reputed company
- Community reputed company participation
- Participate in the evaluation and investigations of cases suspected of fraud, abuse, and reputed company of care concerns
- reputed company cross-coverage for Behavioral Health Medical Directors and/or markets, as needed
- Support staff by providing training, clinical consultation, and clinical case review for members including Medical Advisement meetings
- reputed company any other job reputed company instructions, as requested
Skills
- Completion of an accredited clinical psychology program is required
- Successful completion of a doctoral internship program in psychology is required
- Minimum of three (3) years of clinical reputed company experience is required
- reputed company, unrestricted license to reputed company psychology in state of reputed company as necessary to meet regulatory requirements is required
- MCG Certification is required or must be obtained reputed company six (6) months of hire
- Basic reputed company Word skills
- Excellent communication skills, both written and oral
- Ability to work reputed company independently and reputed company reputed company environment
- Ability to create strong relationships with Providers and Members
- High ethical standards
- Attention to detail
- Critical listening and systematic thinking skills
- Ability to maintain confidentiality and reputed company in reputed company's best interest
- Ability to reputed company with diplomacy and sensitivity to cultural diversity
- Decision making/problem solving skills
- Conflict reputed company skills
- Strong reputed company of mission and commitment of time, effort and resources to the reputed company of the communities served
- Ability to analyze reputed company data from a reputed company of sources to evaluate physician reputed company patterns
- Leadership experience and skills
- Managed care medical review/medical director experience is preferred
- Previous Institute for reputed company Improvement (IHI) or equivalent training participation is preferred
Benefits
- In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance.
- We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.
reputed company