Psychologist (Part-time, Non-Clinical) - PCHP

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day.

Primary Purpose

Parkland Community Health Plan's (PCHP's) Psychologist is responsible for consulting on behavioral health-related utilization management (UM) activities, including the review and evaluation of requests for psychological services and treatments. Responsibilities include, but are not limited to, providing clinical input on prior and concurrent review authorizations, discharge planning, and transitions of care. Ensures the application of evidence-based clinical guidelines in determining the appropriateness of requested psychological services.

Minimum Specifications

Education

• Must have a Doctoral degree in Psychology from an APA accredited university and have completed an internship with an APA accredited program.

Experience

• Two (2) years of behavioral health experience is required.
• Two (2) years of work experience and training in clinical psychology preferred.
• Considerable knowledge of psychology, tests and measurements, and a working knowledge of psychiatry and medicine
• Knowledge of Medicaid requirements is preferred.

Equivalent Education and/or Experience Certification/Registration/Licensure

• Must be licensed as a Psychologist by the Texas State Board of Examiners of Psychologists.

Required Tests for Placement Skills or Special Abilities

• Knowledge of utilization management and case management principles.
• Demonstrates clinical knowledge of mental health, substance abuse, interdisciplinary collaboration, and ambulatory based care
• Demonstrate knowledge and utilization of evidence-based practices relevant to population served (persons who have experienced trauma, those with serious mentally illness or serious emotional disturbance, persons with problematic use of alcohol and other drugs, persons with co-occurring PH/BH conditions, etc.).
• Competency in prior authorization functions including application of criteria and timelines.
• Demonstrates ability to analyze clinical information and accurately apply clinical criteria.
• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
• Proven history of effective communication and counseling skills
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
• Excellent analytical and problem-solving skills.
• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Ability to write clearly and succinctly with a high level of attention to detail.
• Proficient computer and Microsoft Office skills. Ability to learn new software programs.
• Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
• Familiar with InterQual and Texas Medicaid provider procedures manual and utilization guidelines.
• Solid understanding of managed care and medical terminology.
• Knowledge of and competence in use of UM software.
• Foster strong, positive, and effective working relationships with inter-system and intra-system team members, encouraging and supporting interaction among various team members across organizational lines.

Responsibilities

Utilization Management/Quality

Conducts clinical reviews of psychological service authorization requests by applying clinical criteria for medical necessity and appropriateness of care. Recommends approval or escalation of cases to the Medical Director as needed. Reviews clinical psychological service requests from members or providers using evidence based clinical guidelines, analyzes clinical information and correctly applies clinical criteria, advising on the application of evidence-based psychological guidelines and criteria. Identifies members with high-risk psychological conditions or those who may benefit from service coordination or disease management. Provides clinical input on prior and concurrent review authorizations, discharge planning, and transitions of care. Answers utilization management directed telephone calls and managing them in a professional and competent manner. Conducts ongoing availability, monitoring, and oversight of non-clinical staff activities. Performs utilization management functions competently and adheres to the guidelines for prior authorization turn-around times. Integrate health literacy principles into all communication including Members and Providers. Support strategies that meet clinical, quality and network improvement goals.

Coordination Treatment

Works collaboratively with provider network and health services team to coordinate member care. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Uses effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to assure appropriate levels of care are received by members Identifies and utilizes appropriate alternative and non-traditional resources in managing cases

Regulatory and Compliance

Ensures adherence to medically necessary guidelines while offering insights into complex psychological cases requiring additional expertise. Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.

Professional Accountability

Promotes and supports a culturally welcoming and inclusive work environment. Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines. Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls. Recognizes and communicates ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. Always maintains confidentiality. Performs other work as requested that is reasonably related to the employees position, qualifications, and competencies.

Documentation

Provides accurate and complete documentation along with an explanation of the rationale that was used to approve requests. Documents and maintains clinical information in health management systems ensuring all pertinent information is entered in a timely manner and in accordance with department guidelines.

Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.