Licensed Psychologist, Peer Reviewer - Remote in Florida

UnitedHealth Group•Tampa, FL

2d•$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. Join us to start Caring. Connecting. Growing together. This Psychologist Peer Reviewer role focuses on Outpatient Public Sector or Applied Behavior Analysis, involving the application of clinical and benefit plan criteria to Commercial, Medicaid, and/or Medicare cases to make insurance benefit coverage determinations. Services reviewed may include traditional outpatient psychotherapy visits, state-specific Medicaid services (Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.), and Applied Behavior Analysis service requests. The role also includes participation in consultations, staff meetings, and trainings; responsibility for composing and entering clinical determinations that comply with all federal, state, and local requirements; and performing other duties as required by the reviewer’s manager. This is a full-time salaried position requiring availability for a standard schedule: Monday through Friday (8:30 am to 5 pm CST). If located in Florida, there is flexibility to work remotely.

Requirements

Independently licensed doctoral level Psychologist (Ph.D. or Psy.D.) in the state of Florida.
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.
Permanent residence in the state of Florida.

Nice To Haves

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.

Responsibilities

Conduct clinical reviews of requests for service authorization that a Master’s degree level employee is unable to authorize coverage upon initial review.
Review ongoing outpatient care in cases where the member’s length of stay or frequency of visits exceeds normative standards.
Review requests for non-standard outpatient services (e.g., ABA, Psychosocial Rehabilitation, an in-network accommodation).
Review appeals of previously denied services.
Participate in consultations, staff meetings, and trainings.
Compose and enter clinical determinations that comply with all federal, state, and local requirements.
Perform other duties as required by the reviewer’s manager.