Licensed Psychologist, Peer Reviewer - Remote (Tri-state Area)

UnitedHealth Group•Bridgeport, CT

4d•$91,700 - $163,700•Remote

About The Position

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. If you are located in New York, New Jersey, or Connecticut, you will have the flexibility to work remotely as you take on some tough challenges. 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. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Requirements

Licensed doctoral level (Ph.D. or Psy.D.) Psychologist
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)
5+ years of post-licensure experience
Experience completing peer reviews including psychological testing, other Children’s services like CFTSS and HCBS and Mental Health and Substance Use Disorders
Experience working with insurance agencies
Experience working with children and adolescents
Computer skills, including facility with Windows OS, Outlook, Word, and Excel
Proven ability to type proficiently while speaking on the phone
Permanent residence in the state of New York, New Jersey, or Connecticut

Nice To Haves

Experience working in a managed care setting
Clinical experience with children in foster care or knowledge of NYS foster care system
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
Advanced computer skills using Excel and Access Databases
Demonstrated solid organizational and time management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements
Demonstrated solid written and verbal communication and negotiation skills
Proven ability to work well independently and collaborate with others on a clinical team
Proven ability to enjoy a fast paced, changing environment

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
Participate in peer consultations, staff meetings, and trainings; entering determinations within federal, state, and local guideline requirements; and perform of other duties as required by the reviewer’s manager
Conduct Non-MD clinical reviews of the following type during a typical workday
Requests for psychological or neuropsychological testing
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