Psychologist Peer Review Utilization Management - Remote - Remote Eligible

Psychologist Peer Reviewer

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.

Psychologist Peer Reviewer is for an Outpatient Public Sector or Applied Behavior Analysis which involves applying clinical and benefit plan criteria to Commercial, Medicaid, and/or Medicare cases to make insurance benefit coverage determinations.

Services reviewed may include, but are not limited to, the following:

• Traditional outpatient psychotherapy visits
• State-specific Medicaid services (Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
• Applied Behavior Analysis service requests

The Psychologist Peer Reviewer will also participate in consultations, staff meetings, and trainings; be responsible for composing and entering clinical determinations that comply with all federal, state, and local requirements; and perform other duties as required by the reviewer's manager.

This is a full-time salaried position that requires availability to work a standard schedule:

Monday through Friday (8:30am to 5pm CST)

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

Primary Responsibilities:

• May conduct clinical reviews of the following type during a typical workday:
• Requests service authorization that upon initial review which a Master's degree level employee is unable to authorize coverage
• Ongoing outpatient care in cases where the member's length of stay or frequency of visits exceeds normative standards
• Requests for non-standard outpatient services (e.g. ABA, Psychosocial Rehabilitation, an in-network accommodation)
• Appeals of previously denied services

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:

• Independently licensed doctoral level Psychologist (Ph.D. or Psy.D.) in your state of residence
• Ability to obtain additional state licensures to meet growing business needs
• 3+ years of post-licensure experience
• Experience working with insurance companies to acquire authorizations, file claims, conduct peer reviews, etc.
• Advanced proficiency using Microsoft Office Applications (Word, Outlook, TEAMS, Excel, and Access Database)
• Proven ability to prioritize multiple demands within strict turnaround time requirements and track multiple state/business nuances for cases reviewed
• Proven ability to work independently and collaborate with others on a clinical team
• Proven advanced written and verbal communication and negotiation skills
• Secure, private area of your home to set up an office, and access to a broadband ISP

Preferred Qualifications:

• APA accredited training and internship
• Experience working in a managed care setting
• Experience with Public Sector (Medicaid/Medicare) services and HCPC codes/services
• Clinical experience with Substance Abuse diagnoses

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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.