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Licensed Psychologist, Peer Reviewer - Telecommute job in Atlanta at UnitedHealth Group

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Licensed Psychologist, Peer Reviewer - Telecommute at UnitedHealth Group

Licensed Psychologist, Peer Reviewer - Telecommute

UnitedHealth Group Work From Home, GA Full Time

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

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 telecommute* 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; be responsible for entering determinations within federal, state, and local guideline requirements; and perform of 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

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:

  • 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
  • Ability to type proficiently while speaking on the phone

Preferred Qualifications:

  • 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
  • Solid organizational and time - management skills, with the ability to prioritize multiple demands within strict turn - around - time requirements
  • Solid written and verbal communication and negotiation skills
  • Work well independently and collaborate with others on a clinical team
  • Enjoy a fast paced, changing environment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. (sm)

Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. 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 Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

Job Keywords: Psychologist, Therapist, Counselor, Psy.D., Ph.D., Mental Health, Behavioral Health, Peer Review, Managed Care, Medical Necessity, Telecommute, Telecommuter


Recommended Skills

  • Substance Abuse
  • Adolescence
  • Medicaid
  • Case Management
  • Medicare
  • Mental Health
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