[Hiring] Licensed Psychologist, Peer Reviewer @UnitedHealth Group

Role Description

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.

Primary 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 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

Qualifications

• 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

Requirements

• 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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.