Licensed Psychologist, Peer Reviewer - Remote

UnitedHealth Group•Washington, DC

18h•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 Psychologist Peer Review for ALERT 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.

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)
3+ years of post-licensure experience
Experience working with insurance agencies
Computer skills, including facility with Windows OS, Outlook, Word, and Excel
Proven ability to type proficiently while speaking on the phone

Nice To Haves

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
Advanced computer skills using Excel and Access Databases
Proven solid organizational and time management skills, with the ability to prioritize multiple demands within strict turn-around-time requirements
Proven 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
Candidates located in Mountain or Pacific Time Zones are highly preferred

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
Psychological /Neuropsychological Testing service requests
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