Licensed Psychologist, Peer Reviewer - Remote - KY license required

UnitedHealth Group•Owensboro, KY

4d•$91,700 - $163,700•Remote

About The Position

Optum is seeking a Psychologist Peer Reviewer to join their team. This role involves applying clinical and benefit plan criteria to make insurance benefit coverage determinations for Commercial, Medicaid, and/or Medicare cases. Services reviewed may include traditional outpatient psychotherapy, state-specific Medicaid services, and Applied Behavior Analysis (ABA) requests. The position is full-time, salaried, and offers the flexibility to work remotely from anywhere within the U.S. Candidates must be licensed in Kentucky. The role also involves participating in consultations, staff meetings, and trainings, and composing clinical determinations that comply with all federal, state, and local requirements.

Requirements

Independently licensed doctoral level Psychologist (Ph.D. or Psy.D.) in the state of Kentucky.
Ability to obtain additional state licensures to meet growing business needs.
3+ years of post-licensure experience.
Experience dealing with insurance.
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.

Nice To Haves

APA accredited training and internship.
Experience working in a managed care setting.
Peer review experience with managed care.
Experience with Public Sector (Medicaid/Medicare) services and HCPC codes/services.
Clinical experience with Substance Abuse diagnoses.

Responsibilities

Conduct clinical reviews of service authorization requests 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 such as ABA and Psychosocial Rehabilitation, and in-network accommodations.
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.