Licensed Psychologist Peer Reviewer - Remote

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The role of the Psychologist Peer Review for STEM 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.

Work schedule will be Monday to Friday 8:00 AM - 5:00 PM in your time zone.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• State - specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
• Appeals of previously denied services or claims for outpatient Non - MD services up to and including Intensive Outpatient Programming
• Psychological /Neuropsychological Testing service requests
• Intensive Outpatient services for both Mental Health and Substance Abuse
• Requests for non - standard outpatient services (eg, in - network accommodation, intensive outpatient program with no MD involvement)
• Requests for Applied Behavioral Analysis
• 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
• Conduct Non-MD clinical reviews of the following type during a typical workday:
  • Requests for psychological or neuropsychological testing
  • Requests for Applied Behavioral Analysis
  • 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 national standards of care for best practices
  • Requests for non - standard outpatient services (eg, 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
• Standard outpatient treatment including requests for single case agreements
• Review of ongoing outpatient care in cases where the member’s treatment episode exceeds national standards of care for best practices
• Participate in peer consultations, staff meetings, and trainings; for entering determinations within federal, state, and local guideline requirements; and perform of other duties as required by the reviewer’s manager
• Requests for psychological or neuropsychological testing

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.

Required Qualifications:

• 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)
• Computer skills, including facility with Windows OS, Outlook, Word, Teams and Excel
• Licensed doctoral level (Ph.D. or Psy.D.) Psychologist
• 3+ years of post - licensure experience
• Must have a designated secure work space and access to install secure high speed internet via cable/DSL in home

Preferred Qualifications:

• Clinical experience with Substance Abuse diagnoses
• Proven solid organizational and time - management skills, with the ability to prioritize multiple demands within strict turn - around - time requirements
• Clinical experience in higher levels of care (Intensive Outpatient)
• Experience with CPT and HCPC codes
• ASPPB Certificate of Professional Qualification (CPQ)
• Experience working in a managed care setting
• Diplomate of the American Board of Professional Psychology (ABPP)
• Experience with Commercial, Medicaid and Medicare lines of business
• Advanced computer skills using Excel and Access Databases
• Clinical experience with Evidence-Based Treatment
• Experience performing Peer Reviews
• Clinical experience with children and adolescents

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $85,000 to $167,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.