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. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Psychologist Peer Reviewer is for an Outpatient Public Sector or Applied Behavior Analysis which involves applying clinical and benefit plan criteria to Commercial, Medicaid, and/or Medicare cases to make insurance benefit coverage determinations.
Services reviewed may include, but are not limited to, the following:
- Traditional outpatient psychotherapy visits
- State-specific Medicaid services (Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
- Applied Behavior Analysis service requests
The Psychologist Peer Reviewer will also participate in consultations, staff meetings, and trainings; be responsible for composing and entering clinical determinations that comply with all federal, state, and local requirements; and perform other duties as required by the reviewer's manager
This is a full-time salaried position that requires availability to work a standard schedule: Monday through Friday (8:30am to 5pm CST)
If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- May conduct clinical reviews of the following type during a typical workday:
- Requests service authorization that upon initial review which a Master's degree level employee is unable to authorize coverage
- Ongoing outpatient care in cases where the member's length of stay or frequency of visits exceeds normative standards
- Requests for non-standard outpatient services (e.g. ABA, Psychosocial Rehabilitation, an in-network accommodation)
- Appeals of previously denied services
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:
- 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
Preferred Qualifications:
- 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
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.