Licensed Psychologist, Peer Reviewer - ABA Services - Remote

UnitedHealth Group•Maryland Heights, MO

8h•$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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. The Licensed Psychologist, Peer Reviewer for Applied Behavior Analysis (ABA) Services evaluates requests for initial and continued coverage of ABA treatment and assessment services. The Peer Reviewer applies applicable clinical criteria, benefit-plan requirements, and federal, state, and local requirements; discusses clinically appropriate treatment considerations with treating providers; and issues clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.

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 with Autism Spectrum Disorder
Experience working with managed care entities
Proficiency is MS Office Suite
Ability to type proficiently, and for a significant portion of your day comfortably, while speaking on the phone
Solid 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
Ability to work well independently and collaborate with others on a clinical team
Solid written and verbal communication and negotiation skills
Thrive in a fast-paced environment
Have a secure, private area of your home to set up an office, and access to a broadband ISP
Available to work full-time during normal business hours Monday through Friday
Ability and willingness to obtain additional state licenses based on business needs.

Nice To Haves

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

Responsibilities

Review initial and continued-service requests for ABA treatment and assessment services for commercial and Medicaid plans.
Apply clinical criteria, benefit-plan requirements, and applicable federal, state, and local requirements to each review.
Conduct peer-to-peer consultations and discuss clinically appropriate treatment considerations with treating providers.
Compose and enter clear, timely clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
Review requests for single-case agreements and appeals of previously denied services.
Participate in peer consultations, staff meetings, and training activities.
Perform other duties as assigned.