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.

Youll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

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• Standard outpatient treatment, including requests for extended length sessions or single case agreements
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• State - specific Medicaid services (e.g. Psychosocial Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment, etc.)
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• Intensive Outpatient services for both Mental Health and Substance Abuse
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• Psychological /Neuropsychological Testing service requests
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• The Psychologist Reviewer will also 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 reviewers manager
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• The Psychologist may conduct Non-MD clinical reviews of the following type during a typical workday:""
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  • Requests for psychological or neuropsychological testing
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  • 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
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  • Review of ongoing outpatient care in cases where the members treatment episode exceeds normative standards
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  • Requests for non - standard outpatient services (extended - length visits, an in - network accommodation, intensive outpatient program with no MD involvement)
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  • Appeals of previously denied services or claims for outpatient Non - MD services up to and including Intensive Outpatient Programming
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Youll 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:

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• Licensed doctoral level (Ph.D. or Psy.D.) Psychologist in your state of residence
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• 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)
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• Minimum of 3 years post - licensure experience
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• Strong organizational and time - management skills, with the ability to prioritize multiple demands within strict turn - around - time requirements
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• Strong written and verbal communication and negotiation skills
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• Work well independently and collaborate with others on a clinical team
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• Enjoy a fast paced, changing environment
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• Experience working with insurance agencies
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• Computer skills, including facility with Windows OS, Outlook, Word, and Excel
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• Ability to type proficiently while speaking on the phone
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• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employee must comply with any state and local masking orders
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Preferred Qualifications:

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• Prior experience working in a managed care setting
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• Experience performing Peer Reviews
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• Experience with commercial, Medicaid and Medicare lines of business
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• Experience with CPT and HCPC codes
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• Clinical experience in higher levels of care (Intensive Outpatient)
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• Clinical experience with children and adolescents
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• Clinical experience with Substance Abuse diagnoses
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• Clinical experience with Evidence-Based Treatment
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• Advanced computer skills using Excel and Access Databases
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• Candidates with residence and licensure in the state of Indiana or California are preferred
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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)

*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy

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, youll find a far-reaching choice of benefits and incentives

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.
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"Job Keywords: psychologist, therapist, counselor, Psy.D., Ph.D., mental health, behavioral health, peer review, managed care, medical necessity, telecommute, telecommuter, Indiana, California