Licensed Psychologist Peer Reviewer - ABA Autism - Remote

UnitedHealth Group•Tampa, FL

1d•$91,700 - $163,700•Remote

About The Position

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 Behavioral Clinical Consultant, Peer Reviewer for ABA Services involves applying clinical and benefit plan criteria to service requests for initial and continued coverage of ABA treatment, shaping and modifying treatment as appropriate, and issuing an adverse benefit determination if treatment is not medically necessary. Services reviewed may include, but are not limited to, the following: Applied Behavior Analysis service requests for both Commercial and Medicaid Plans The Peer Reviewer will also participate in peer consultations, staff meetings, and trainings; be responsible for composing and entering clinical determinations that comply with all federal, state, and local guideline requirements; and perform other duties as required. The Psychologist Reviewer may conduct clinical reviews of the following type during a typical workday: Clinical review of requests for ABA and Assessment services Requests for Single Case Agreements Appeals of previously denied services You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. 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.

Requirements

Licensed doctoral level Psychologist (Ph.D. or Psy.D.). Your license must be current, 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
Clinical experience diagnosing and treating people with Autism Spectrum Disorder
Experience working with managed care entities
Proven organizational and time-management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements and track multiple state and business nuances for the cases you review
Proven written and verbal communication and negotiation skills
Proven ability to work independently and collaborate with others on a clinical team
Proven ability to thrive in a fast-paced environment
Proven computer skills, including facility with Windows OS, Outlook, Word, and Excel
Proven ability to type proficiently, and for a significant portion of your day comfortably, while speaking on the phone
Proven secure, private area of your home to set up an office, and access to a broadband ISP
Proven ability to work full-time during normal business hours Monday through Friday

Nice To Haves

BCBA, BCBA-D, LBA (in addition to being a licensed psychologist)
Applied Behavior Analysis training and/or experience
APA accredited training and internship
Psychologist licensed in AZ, CA, FL, GA, IN, KY, MA, MN, MS
Clinical experience with children and adolescents
Experience working in a managed care setting
Peer review experience with managed care
Proven Behavior Modification expertise
Proven advanced computer skills using Excel and Access Databases

Responsibilities

Applying clinical and benefit plan criteria to service requests for initial and continued coverage of ABA treatment
Shaping and modifying treatment as appropriate
Issuing an adverse benefit determination if treatment is not medically necessary
Participating in peer consultations, staff meetings, and trainings
Composing and entering clinical determinations that comply with all federal, state, and local guideline requirements
Clinical review of requests for ABA and Assessment services
Requests for Single Case Agreements
Appeals of previously denied services