Clinical Peer Reviewer (Licensed Psychologist w/BCBA) - Evernorth Health Services - Remote

Performs peer review and case management activities.

Delivers clinical expertise to the organization through peer review, decision making, training, management consultation as relates to care management.

Works across all business lines and customers in making medical appropriateness and medical necessity decisions based on clinical protocols, scientific evidence, case information, and best clinical thinking.

Helps to develop and shape clinical policy and procedures and assures that there is standardization across sites/teams on clinical practices.

RESPONSIBILITIES INCLUDE:


* Performs clinical and administrative peer review and appeals, case management, and case consultation activities.


* Participates in inter-rater reliability testing and clinical guidelines training.


* Serves as mentor/coach to Care Managers, Clinical Managers, Providers and other Peer Reviewers in clinical quality improvement process.


* Acts as behavioral health consultant in areas of clinical expertise.


* Improves provider relations through knowledgeable, evidence-driven peer review and positive collegial relationships.


* Improves clinical outcomes through excellence of negotiation, education, and communication skills.


* Model the solution-focused management style for all clinical staff in order to assure the most positive work force possible.


* Develop clinical and administrative trainings that help to educate the clinical staff to Cigna's Clinical Philosophy, new Clinical Work Flows, Clinical Theory and Application, and Accreditation standards.


* Participates in Clinical Team staff meetings and trends issues in order to proactively determine if there are any training needs or work flow modifications.

Follows-up on the determined needs.


* Interface with Customers, Participants and/or Providers as needed to attend to clinical issues.

In addition, model for staff the need to take into account the Customer, the provider, and/or the participant's world view when making decisions and enhancements to service delivery.

QUALIFICATIONS:


* Doctoral Degree in Psychology.

BCBA or BCBA-D Certification preferred.


* Current unrestricted Psychologist license to practice from a licensing agency within the United States.


* At least 5 years of clinical experience post licensure.


* 2 plus years related supervisory/management experience gained in an appropriate clinical setting preferred.


* Must exhibit strong leadership and sound decision making qualities.


* Thorough knowledge of the principles and techniques of psychiatric, mental health/substance abuse diagnosis and treatment.


* Experience with or exposure to managed care delivery and services.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering...