Psychologist Peer Review Utilization Management - Remote - Remote Eligible

Psychologist Peer Review

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The role of the Psychologist Peer Review involves applying clinical criteria and benefit plan requirements to Commercial, Medicaid, and Medicare cases, and making clinical and/or benefit determinations to continue coverage of treatment, shaping and modifying treatment as appropriate, or issuing an adverse benefit determination if applicable criteria is not met.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Standard outpatient treatment, including requests for extended length sessions or single case agreements
• State-specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
• Intensive Outpatient services for both Mental Health and Substance Abuse
• The Psychologist Reviewer will also participate in peer consultations, staff meetings, and trainings; be responsible for entering determinations within federal, state, and local guideline requirements; and perform other duties as required by the reviewer's manager
• Review of outpatient treatment plans for services that are sent for Peer Review that do not appear to meet clinical criteria and/or when there are concerns about the quality of care
• Review of ongoing outpatient care in cases where the member's treatment episode exceeds normative standards
• Requests for non-standard outpatient services (extended-length visits, an in-network accommodation, intensive outpatient program with no MD involvement)
• Appeals of previously denied services or claims for outpatient Non-MD services up to and including Intensive Outpatient Programming

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Licensed doctoral level (Ph.D. or Psy.D.) Psychologist in your state of residence
• Current License, allow for full independent practice, and be unrestricted (you may be asked to obtain additional state licenses to meet growing business needs)
• 3+ years of post-licensure experience
• Experience working with insurance agencies to obtain authorizations, conduct peer reviews, claims, etc
• Computer skills, including facility with Windows OS, Outlook, Word, and Excel
• Ability to type proficiently while speaking on the phone

Preferred Qualifications:

• Experience working in a managed care setting
• Experience performing Peer Reviews
• Experience with commercial, Medicaid and Medicare lines of business
• Experience with CPT and HCPC codes
• Clinical experience in higher levels of care (Intensive Outpatient)
• Clinical experience with children and adolescents
• Clinical experience with Substance Abuse diagnoses
• Clinical experience with Evidence-Based Treatment
• Experience with Psychological/Neuropsychological Testing service requests
• Advanced computer skills using Excel and Access Databases

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.