[Hiring] Licensed Psychologist, Peer Reviewer @UnitedHealth Group

Role Description

The Licensed Psychologist, Peer Reviewer for Applied Behavior Analysis (ABA) Services evaluates requests for initial and continued coverage of ABA treatment and assessment services. The Peer Reviewer applies applicable clinical criteria, benefit-plan requirements, and federal, state, and local requirements; discusses clinically appropriate treatment considerations with treating providers; and issues clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.

• Review initial and continued-service requests for ABA treatment and assessment services for commercial and Medicaid plans.
• Apply clinical criteria, benefit-plan requirements, and applicable federal, state, and local requirements to each review.
• Conduct peer-to-peer consultations and discuss clinically appropriate treatment considerations with treating providers.
• Compose and enter clear, timely clinical determinations, including adverse benefit determinations when requested services do not meet medical-necessity requirements.
• Review requests for single-case agreements and appeals of previously denied services.
• Participate in peer consultations, staff meetings, and training activities.
• Perform other duties as assigned.

Qualifications

• Licensed doctoral level Psychologist (Ph.D. or Psy.D.)
• Your license must be current, allow for full independent practice, and be unrestricted.
• 3+ years of post-licensure experience.
• Clinical experience with Autism Spectrum Disorder.
• Experience working with managed care entities.
• Proficiency in MS Office Suite.
• Ability to type proficiently while speaking on the phone.
• Solid organizational and time-management skills.
• Ability to work well independently and collaborate with others on a clinical team.
• Solid written and verbal communication and negotiation skills.
• Thrive in a fast-paced environment.
• Have a secure, private area of your home to set up an office, and access to a broadband ISP.
• Available to work full-time during normal business hours Monday through Friday.
• Ability and willingness to obtain additional state licenses based on business needs.

Requirements

• Psychologists licensed in AZ, CA, FL, GA, IN, KY, MA, MN, or MS.
• BCBA, BCBA-D, LBA (in addition to being a licensed psychologist).
• APA accredited training and internship.
• Applied Behavior Analysis training and/or experience.
• Clinical experience with children and adolescents.
• Experience working in a managed care setting.
• Peer review experience with managed care.
• Behavior Modification expertise.
• Advanced computer skills using Excel and Access Databases.

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.